Provider Demographics
NPI:1649941006
Name:KEESLER, MELISSA (PT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:KEESLER
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 1:1100 QUAKER HILL DR APT 308
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4749
Mailing Address - Country:US
Mailing Address - Phone:607-341-1247
Mailing Address - Fax:
Practice Address - Street 1:2131K S ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-4011
Practice Address - Country:US
Practice Address - Phone:202-375-7694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28650225100000X
DCPT872214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist