Healthcare Provider Details

I. General information

NPI: 1578243242
Provider Name (Legal Business Name): KEELY CADDELL PRICE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1591 YANCEYVILLE ST STE 400
GREENSBORO NC
27405-6945
US

IV. Provider business mailing address

1650 LYNDON FARM CT STE 300
LOUISVILLE KY
40223-5005
US

V. Phone/Fax

Practice location:
  • Phone: 336-274-7480
  • Fax: 336-274-8903
Mailing address:
  • Phone: 502-882-9379
  • Fax: 502-805-0526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP22349
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: