Provider Demographics
NPI:1477625820
Name:KEISTER, JAMES D (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:KEISTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 THORNTON DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-3928
Mailing Address - Country:US
Mailing Address - Phone:806-358-6847
Mailing Address - Fax:806-358-1782
Practice Address - Street 1:3420 THORNTON DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-3928
Practice Address - Country:US
Practice Address - Phone:806-358-6847
Practice Address - Fax:806-358-1782
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000073225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX650277Medicare ID - Type Unspecified