Provider Demographics
NPI:1093493546
Name:PERKINS, KEISHA (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:
Last Name:PERKINS
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:KEISHA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4054 HYDE PARK DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-4823
Mailing Address - Country:US
Mailing Address - Phone:801-687-3513
Mailing Address - Fax:
Practice Address - Street 1:9325 MIDLOTHIAN TPKE STE A
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4943
Practice Address - Country:US
Practice Address - Phone:757-490-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052158162251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics