Provider Demographics
NPI:1528060282
Name:KEISER, DOUGLAS BRIAN (MPT)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:BRIAN
Last Name:KEISER
Suffix:
Gender:M
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 1107
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-0049
Mailing Address - Country:US
Mailing Address - Phone:319-277-3166
Mailing Address - Fax:319-266-4846
Practice Address - Street 1:211 W 6TH ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2859
Practice Address - Country:US
Practice Address - Phone:319-277-3166
Practice Address - Fax:319-266-4846
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01593225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA54448OtherWELLMARK BC/BS OF IOWA