Provider Demographics
NPI:1619368131
Name:KAEHELE, DEAN F (PTA, CSST)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:F
Last Name:KAEHELE
Suffix:
Gender:M
Credentials:PTA, CSST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 MURIEL ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-4440
Mailing Address - Country:US
Mailing Address - Phone:505-417-4338
Mailing Address - Fax:
Practice Address - Street 1:1605 MURIEL ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-4440
Practice Address - Country:US
Practice Address - Phone:505-417-4338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0698225200000X
NMA-0783225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA-0783OtherNEW MEXICO PHYSICAL THERAPY BOARD