Provider Demographics
NPI:1851104202
Name:MCGEE, KEISHA SHANTE
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:SHANTE
Last Name:MCGEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4570 N CENTRAL AVE APT 213
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1838
Mailing Address - Country:US
Mailing Address - Phone:623-570-2473
Mailing Address - Fax:
Practice Address - Street 1:3131 E THUNDERBIRD RD STE 51
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5642
Practice Address - Country:US
Practice Address - Phone:623-570-2473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT20645225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist