Provider Demographics
NPI:1578070694
Name:CHAFFEE, KEELEY PATRICIA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KEELEY
Middle Name:PATRICIA
Last Name:CHAFFEE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2999 HALLOCK YOUNG RD SW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44481-9278
Mailing Address - Country:US
Mailing Address - Phone:330-774-0435
Mailing Address - Fax:
Practice Address - Street 1:15950 PIERCE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEFIELD
Practice Address - State:OH
Practice Address - Zip Code:44062-9577
Practice Address - Country:US
Practice Address - Phone:440-423-5787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT017229225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty