Healthcare Provider Details

I. General information

NPI: 1447170105
Provider Name (Legal Business Name): TINA RENEE KEIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W DOLPHIN ST
SILER CITY NC
27344-3711
US

IV. Provider business mailing address

133 WINNIPEG RD
NORTH AUGUSTA SC
29841-3935
US

V. Phone/Fax

Practice location:
  • Phone: 919-663-3431
  • Fax:
Mailing address:
  • Phone: 706-836-9740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: