Provider Demographics
NPI:1306178926
Name:KESWICK, DENISE RENEE (PTA)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:RENEE
Last Name:KESWICK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 W LOUISE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5939
Mailing Address - Country:US
Mailing Address - Phone:623-695-2601
Mailing Address - Fax:
Practice Address - Street 1:7010 W LOUISE DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-5939
Practice Address - Country:US
Practice Address - Phone:623-695-2601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-06
Last Update Date:2010-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8133A172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker