Provider Demographics
NPI:1417140633
Name:KEEYS JORDAN, KIM (PT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:KEEYS JORDAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:TRUTH OR CONSEQUENCES
Mailing Address - State:NM
Mailing Address - Zip Code:87901-1954
Mailing Address - Country:US
Mailing Address - Phone:505-743-1213
Mailing Address - Fax:505-743-1263
Practice Address - Street 1:800 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:TRUTH OR CONSEQUENCES
Practice Address - State:NM
Practice Address - Zip Code:87901-1954
Practice Address - Country:US
Practice Address - Phone:505-743-1213
Practice Address - Fax:505-743-1263
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2632225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist