Healthcare Provider Details

I. General information

NPI: 1659289437
Provider Name (Legal Business Name): KRISTINA KEISER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 NISSAN DR
CANTON MS
39046-8562
US

IV. Provider business mailing address

314 TRACE HARBOR RD
MADISON MS
39110-8765
US

V. Phone/Fax

Practice location:
  • Phone: 601-855-6994
  • Fax:
Mailing address:
  • Phone: 662-832-9055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT7946
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: