Healthcare Provider Details

I. General information

NPI: 1164759536
Provider Name (Legal Business Name): A'NDREA KEATING LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39717 N 3RD ST
DESERT HILLS AZ
85086-7901
US

IV. Provider business mailing address

39717 N 3RD ST
DESERT HILLS AZ
85086-7901
US

V. Phone/Fax

Practice location:
  • Phone: 602-618-7590
  • Fax:
Mailing address:
  • Phone: 602-618-7590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMT-01354P
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: