MEDICARE: KATHRYN M AFFLECK PT

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	PT16034	CA
2	2251X0800X	Orthopedic Physical Therapist	PT16034	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WPT16034C	OTHER		PPIN

General Provider Information

NPI Number	:	1922026491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN M AFFLECK PT

Provider Business Mailing Address
First Line	:	9850 GENESEE AVE
Second Line	:	STE 210
City	:	LA JOLLA
State	:	CA
Zip	:	92037-1206
Country	:	US
Telephone Number	:	858-535-1075
Fax Number	:	858-453-9810

Provider Business Practice Location Address
First Line	:	4520 EXECUTIVE DR
Second Line	:	STE 101
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3023
Country	:	US
Telephone Number	:	858-535-1894
Fax Number	:	858-535-1894

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	09/11/2025

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Directions to “ KATHRYN M AFFLECK PT” Practice Location

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