Provider Demographics
NPI:1346673860
Name:KEAFER DEROUSSE, KRISTIN A (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:A
Last Name:KEAFER DEROUSSE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:A
Other - Last Name:KEAFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:73 NEWTON RD
Mailing Address - Street 2:STE 101
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-2424
Mailing Address - Country:US
Mailing Address - Phone:978-388-7272
Mailing Address - Fax:978-388-7373
Practice Address - Street 1:881 LAFAYETTE RD
Practice Address - Street 2:UNIT K
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-1242
Practice Address - Country:US
Practice Address - Phone:603-929-2880
Practice Address - Fax:603-929-1296
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4114225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist