Provider Demographics
NPI:1902344401
Name:KEEFER, KAITLYN
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:KEEFER
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 1:384 MIDDLECREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:15557-7312
Mailing Address - Country:US
Mailing Address - Phone:814-289-1763
Mailing Address - Fax:
Practice Address - Street 1:384 MIDDLECREEK RD
Practice Address - Street 2:
Practice Address - City:ROCKWOOD
Practice Address - State:PA
Practice Address - Zip Code:15557-7312
Practice Address - Country:US
Practice Address - Phone:814-289-1763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025793225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist