Provider Demographics
NPI:1346901097
Name:ROEHL, KEITH (DPT)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:ROEHL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6855 DONNELAITH PL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-3110
Mailing Address - Country:US
Mailing Address - Phone:320-266-8477
Mailing Address - Fax:
Practice Address - Street 1:7622 MCLAUGHLIN RD
Practice Address - Street 2:
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-4710
Practice Address - Country:US
Practice Address - Phone:719-495-3133
Practice Address - Fax:719-471-4415
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0019523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist