Provider Demographics
NPI:1659962520
Name:KEYSER, KAITLYN RUTH (PT, DPT, ATC, CSCS)
Entity Type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:RUTH
Last Name:KEYSER
Suffix:
Gender:F
Credentials:PT, DPT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W RIO SALADO PKWY APT 4033
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-6289
Mailing Address - Country:US
Mailing Address - Phone:240-216-3219
Mailing Address - Fax:
Practice Address - Street 1:5750 S 32ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-3833
Practice Address - Country:US
Practice Address - Phone:602-437-5395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10805R208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation