Provider Demographics
NPI:1992791784
Name:KEAHEY-OBERDORFER, LINDA (PT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:KEAHEY-OBERDORFER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:OBERDORFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:9624 ALLANDE RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6620
Mailing Address - Country:US
Mailing Address - Phone:505-823-2411
Mailing Address - Fax:505-858-0650
Practice Address - Street 1:6100 SEAGULL ST NE
Practice Address - Street 2:SUITE B-102
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2500
Practice Address - Country:US
Practice Address - Phone:505-823-2411
Practice Address - Fax:505-858-0650
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist