Provider Demographics
NPI:1174263438
Name:KEELING, MAIYA (ACSM RCEP, NBC-WHC)
Entity Type:Individual
Prefix:
First Name:MAIYA
Middle Name:
Last Name:KEELING
Suffix:
Gender:F
Credentials:ACSM RCEP, NBC-WHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9737 DOMINION CREST DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-7024
Mailing Address - Country:US
Mailing Address - Phone:704-654-5154
Mailing Address - Fax:
Practice Address - Street 1:9737 DOMINION CREST DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-7024
Practice Address - Country:US
Practice Address - Phone:704-654-5154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA-3279437171400000X
NC244511135224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty