Provider Demographics
NPI:1679860001
Name:KELTO, BENJAMIN C (DPT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:C
Last Name:KELTO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9255 E KEATS AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-2526
Mailing Address - Country:US
Mailing Address - Phone:906-250-3063
Mailing Address - Fax:
Practice Address - Street 1:1257 W WARNER RD
Practice Address - Street 2:SUITE A-2
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2713
Practice Address - Country:US
Practice Address - Phone:480-821-2286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist