Healthcare Provider Details

I. General information

NPI: 1528557980
Provider Name (Legal Business Name): AUDREY KEELER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUDREY FRICK PTA

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W WASHINGTON AVE
STERLING KS
67579-1615
US

IV. Provider business mailing address

200 W DOUGLAS AVE STE 250
WICHITA KS
67202-3002
US

V. Phone/Fax

Practice location:
  • Phone: 620-204-6116
  • Fax:
Mailing address:
  • Phone: 316-263-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-03344
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: