Provider Demographics
NPI:1477790798
Name:KEIDONG, CHRIS (PT)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:KEIDONG
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 1:1207 ROUTE 9
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-4986
Mailing Address - Country:US
Mailing Address - Phone:845-297-3200
Mailing Address - Fax:845-297-7891
Practice Address - Street 1:200 S RIDGE ST
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-3434
Practice Address - Country:US
Practice Address - Phone:845-297-3200
Practice Address - Fax:845-297-7891
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021682-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist