Provider Demographics
NPI:1346565017
Name:KEISTER, TARA LYNN (MPT)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:KEISTER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 46
Mailing Address - Street 2:987 BROOKVILLE ST
Mailing Address - City:FAIRMOUNT CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16224-0046
Mailing Address - Country:US
Mailing Address - Phone:814-275-1000
Mailing Address - Fax:814-275-1003
Practice Address - Street 1:987 BROOKVILLE ST
Practice Address - Street 2:
Practice Address - City:FAIRMOUNT CITY
Practice Address - State:PA
Practice Address - Zip Code:16224-0046
Practice Address - Country:US
Practice Address - Phone:814-275-1000
Practice Address - Fax:814-275-1003
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020206225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist