Provider Demographics
NPI:1760007645
Name:WILLIAMS SKEETE, KEIONA KRISTAL ASHLEY (DPT)
Entity Type:Individual
Prefix:DR
First Name:KEIONA
Middle Name:KRISTAL ASHLEY
Last Name:WILLIAMS SKEETE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:KEIONA
Other - Middle Name:KRISTAL ASHLEY
Other - Last Name:SKEETE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:72 ALBANY ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-5013
Mailing Address - Country:US
Mailing Address - Phone:718-598-3871
Mailing Address - Fax:
Practice Address - Street 1:72 ALBANY ST
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-5013
Practice Address - Country:US
Practice Address - Phone:718-598-3871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04522701225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist