MEDICARE: DR. KATIE MITCHELL DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT293459	CA

General Provider Information

NPI Number	:	1851899496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATIE MITCHELL DPT

Provider Business Mailing Address
First Line	:	4343 1/2 OREGON ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-1210
Country	:	US
Telephone Number	:	559-719-7088
Fax Number	:

Provider Business Practice Location Address
First Line	:	667 SOLANA HILLS CT
Second Line	:
City	:	SOLANA BEACH
State	:	CA
Zip	:	92075-1421
Country	:	US
Telephone Number	:	858-255-0092
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2018
Last Update Date	:	01/29/2018

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