Provider Demographics
NPI:1194409375
Name:KEETCH, HENSEN P (PT, DPT)
Entity type:Individual
Prefix:
First Name:HENSEN
Middle Name:P
Last Name:KEETCH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W SPRUCE WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84119-6583
Mailing Address - Country:US
Mailing Address - Phone:385-225-1047
Mailing Address - Fax:
Practice Address - Street 1:2730 E 3300 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-2819
Practice Address - Country:US
Practice Address - Phone:801-487-0896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11039300-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist