Provider Demographics
NPI:1194491936
Name:KEYSE, TRUDY LU (DPT)
Entity type:Individual
Prefix:
First Name:TRUDY
Middle Name:LU
Last Name:KEYSE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5533 MAHONING AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2366
Mailing Address - Country:US
Mailing Address - Phone:330-799-0094
Mailing Address - Fax:330-799-8303
Practice Address - Street 1:5533 MAHONING AVE FL 2
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2366
Practice Address - Country:US
Practice Address - Phone:330-799-0094
Practice Address - Fax:330-799-8303
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT012848225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist