Provider Demographics
NPI:1770525677
Name:KEHS, ALISSA A (PT)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:A
Last Name:KEHS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:
Other - Last Name:FREIWALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:774 JACQUELINE LANE
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-4206
Mailing Address - Country:US
Mailing Address - Phone:484-793-2174
Mailing Address - Fax:
Practice Address - Street 1:8254 118TH AVENUE NORTH
Practice Address - Street 2:SUITE 100
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773
Practice Address - Country:US
Practice Address - Phone:727-541-5304
Practice Address - Fax:727-546-8527
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016925208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation