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NPI Code Detail

MEDICARE: KYRENE KEETO BETOURNAY

MEDICARE: KYRENE KEETO BETOURNAY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantPTA-014550AZ

General Provider Information

NPI Number : 1164384566
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYRENE KEETO BETOURNAY
Provider Business Mailing Address
First Line : 973 W CAPULIN TRL
Second Line :
City : SAN TAN VALLEY
State : AZ
Zip : 85140-5595
Country : US
Telephone Number : 602-737-2275
Fax Number :
Provider Business Practice Location Address
First Line : 21576 S ELLSWORTH LOOP RD STE 108
Second Line :
City : QUEEN CREEK
State : AZ
Zip : 85142-1068
Country : US
Telephone Number : 602-737-2275
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/25/2025
Last Update Date : 11/25/2025

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Directions to “ KYRENE KEETO BETOURNAY ” Practice Location

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