Provider Demographics
NPI:1366471906
Name:KEISLING, BRAD D (MSPT,CSCS)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:D
Last Name:KEISLING
Suffix:
Gender:M
Credentials:MSPT,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MAIN ST STE 200A4
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-4628
Mailing Address - Country:US
Mailing Address - Phone:843-441-0595
Mailing Address - Fax:
Practice Address - Street 1:1076 RIBAUT RD STE 102
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5490
Practice Address - Country:US
Practice Address - Phone:843-525-0045
Practice Address - Fax:435-250-8268
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4334225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00415441OtherRAILROAD MEDICARE
SCP00221129OtherRAILROAD PROVIDER NUMBER