Healthcare Provider Details

I. General information

NPI: 1407774441
Provider Name (Legal Business Name): KYLE C KEITH PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GROVE ST STE 100
HADDON HEIGHTS NJ
08035-1761
US

IV. Provider business mailing address

124 S MAIN ST
ELMER NJ
08318-2233
US

V. Phone/Fax

Practice location:
  • Phone: 856-617-0175
  • Fax:
Mailing address:
  • Phone: 609-850-1367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: