Provider Demographics
NPI:1750501755
Name:KEYSER, MARTHA ANNE (PT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANNE
Last Name:KEYSER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13101 DEER DANCER TRL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-4832
Mailing Address - Country:US
Mailing Address - Phone:505-720-1045
Mailing Address - Fax:
Practice Address - Street 1:13101 DEER DANCER TRL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-4832
Practice Address - Country:US
Practice Address - Phone:505-720-1045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM774225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist