Provider Demographics
NPI:1114099330
Name:DUERLER, KEITH ANDREW (PT)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:ANDREW
Last Name:DUERLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911063
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40591-1063
Mailing Address - Country:US
Mailing Address - Phone:859-797-5513
Mailing Address - Fax:859-898-0538
Practice Address - Street 1:880 CORPORATE DR STE 202
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-5449
Practice Address - Country:US
Practice Address - Phone:859-797-5513
Practice Address - Fax:859-258-8592
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003352225100000X
KYPT-0033522251S0007X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYASC1019OtherASC MEDICARE GROUP
KY4000501OtherMEDICARE LAB GROUP
KY37903705OtherMEDICAID LAB GROUP
KY36000818OtherASC MEDICAID GROUP
KYCB5773OtherRR GROUP
KYP00224418OtherRR MEDICARE PIN
KY0091220Medicare ID - Type Unspecified
KYP00224418OtherRR MEDICARE PIN
KY37903705OtherMEDICAID LAB GROUP