Provider Demographics
NPI:1154859536
Name:KEYZER, KELLY ANN (DPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:KEYZER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-1532
Mailing Address - Country:US
Mailing Address - Phone:224-595-4839
Mailing Address - Fax:
Practice Address - Street 1:2504 FREMONT ST
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-1532
Practice Address - Country:US
Practice Address - Phone:224-595-4839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist