Provider Demographics
NPI:1114651528
Name:GAILES, KEELI TRITZ (PT, DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:KEELI
Middle Name:TRITZ
Last Name:GAILES
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 FOREYS CT
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-8179
Mailing Address - Country:US
Mailing Address - Phone:850-541-2926
Mailing Address - Fax:
Practice Address - Street 1:1175 REVOLUTION MILL DR STE 34L
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5168
Practice Address - Country:US
Practice Address - Phone:336-707-9951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
NC18406225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer