Provider Demographics
NPI:1952068116
Name:ROZELL, KEITH DUANE (PTA)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:DUANE
Last Name:ROZELL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12104 TWO TOP RD
Mailing Address - Street 2:
Mailing Address - City:MERCERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17236-9733
Mailing Address - Country:US
Mailing Address - Phone:717-328-4514
Mailing Address - Fax:
Practice Address - Street 1:1008 TAVERN RD STE 200
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2801
Practice Address - Country:US
Practice Address - Phone:304-267-0866
Practice Address - Fax:304-267-8348
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA5066225200000X
WV470225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant