Provider Demographics
NPI:1063475721
Name:ABRUZZESE, KEITH R (DPT)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:R
Last Name:ABRUZZESE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 HURFFVILLE CROSSKEYS RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-4001
Mailing Address - Country:US
Mailing Address - Phone:609-458-1119
Mailing Address - Fax:
Practice Address - Street 1:239 HURFFVILLE CROSSKEYS RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-4001
Practice Address - Country:US
Practice Address - Phone:856-341-8510
Practice Address - Fax:856-341-8505
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01020500225100000X
PAPT017215225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist