Provider Demographics
NPI:1790068625
Name:KEESLER, BREENA JEAN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:BREENA
Middle Name:JEAN
Last Name:KEESLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4960 S. GILBERT RD.
Mailing Address - Street 2:STE. 1-496
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249
Mailing Address - Country:US
Mailing Address - Phone:480-917-2745
Mailing Address - Fax:888-243-7186
Practice Address - Street 1:1855 E SOUTHERN AVE
Practice Address - Street 2:STE. 107
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5241
Practice Address - Country:US
Practice Address - Phone:480-917-2745
Practice Address - Fax:888-243-7186
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007114225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant