Healthcare Provider Details

I. General information

NPI: 1487578464
Provider Name (Legal Business Name): KRYSTAL KEELER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4231 W YORKSHIRE DR
GLENDALE AZ
85308-7556
US

IV. Provider business mailing address

4957 W MICHIGAN AVE
GLENDALE AZ
85308-1423
US

V. Phone/Fax

Practice location:
  • Phone: 480-262-0867
  • Fax:
Mailing address:
  • Phone: 480-262-0867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-13036
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: