Provider Demographics
NPI:1407128762
Name:KEISTER, RUTH ANNE
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ANNE
Last Name:KEISTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8505 FENTON ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4497
Mailing Address - Country:US
Mailing Address - Phone:301-565-4924
Mailing Address - Fax:301-565-4927
Practice Address - Street 1:8505 FENTON ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4497
Practice Address - Country:US
Practice Address - Phone:301-565-4924
Practice Address - Fax:301-565-4927
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM00896225700000X
DCMT83225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist