Provider Demographics
NPI:1376884668
Name:ALFEROS, KEONE MARK (DPT)
Entity Type:Individual
Prefix:DR
First Name:KEONE
Middle Name:MARK
Last Name:ALFEROS
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 1:8745 CLEBURN DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3224
Mailing Address - Country:US
Mailing Address - Phone:619-339-4785
Mailing Address - Fax:
Practice Address - Street 1:8745 CLEBURN DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3224
Practice Address - Country:US
Practice Address - Phone:619-339-4785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39614225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist