Provider Demographics
NPI:1376235093
Name:KEUCK, DREW MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:MARIE
Last Name:KEUCK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3967 S NEBRASKA ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-4574
Mailing Address - Country:US
Mailing Address - Phone:712-301-9599
Mailing Address - Fax:
Practice Address - Street 1:37200 N GANTZEL RD STE 260
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-7387
Practice Address - Country:US
Practice Address - Phone:480-690-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist