Provider Demographics
NPI:1265048722
Name:KEELEY, KAITLIN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:KEELEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BANK ST APT 920
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-2026
Mailing Address - Country:US
Mailing Address - Phone:540-435-4364
Mailing Address - Fax:
Practice Address - Street 1:342 FIFTH AVE
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-1204
Practice Address - Country:US
Practice Address - Phone:914-738-1748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213843225100000X
NY046499225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist