Healthcare Provider Details

I. General information

NPI: 1982979209
Provider Name (Legal Business Name): KEIRA GEFROH MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KEIRA BECK

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 EDDIE HOFFMAN HIGHWAY
BETHEL AK
99559
US

IV. Provider business mailing address

P.O. BOX 287 PHYSICAL THERAPY DEPT.
BETHEL AK
99559
US

V. Phone/Fax

Practice location:
  • Phone: 907-543-6695
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2474
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: