Provider Demographics
NPI:1609356302
Name:KEFFELER, JOSIE (PTA)
Entity Type:Individual
Prefix:
First Name:JOSIE
Middle Name:
Last Name:KEFFELER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10115 SAHARA ST APT 702
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-3808
Mailing Address - Country:US
Mailing Address - Phone:402-201-5832
Mailing Address - Fax:
Practice Address - Street 1:636 CUPPLES RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-4328
Practice Address - Country:US
Practice Address - Phone:210-434-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2052263225200000X
NE648225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant