Individual ProviderKevin DonnellanPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address7450 Girard Ave, La Jolla, CA 92037-5142(858) 454-9769(631) 807-5354PECOS EnrollmentBased on the most recent information from CMS, provider Kevin Donnellan does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1710082011Provider TypeIndividualFull NameDonnellan, KevinCredentialMSPTGenderMaleSole ProprietorNoEnumeration Date9/13/2006Last Updated4/15/2008Contact InformationPractice LocationPractice Address7450 Girard Ave, La Jolla, CA 92037-5142Phone(858) 454-9769FaxUnlisted FaxMailing LocationMailing Address1510 Summit Ave, Cardiff, CA 92007-2434Phone(631) 807-5354FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense33148CaliforniaCode225100000XDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense024711New York