Healthcare Provider Details

I. General information

NPI: 1619368131
Provider Name (Legal Business Name): DEAN F KAEHELE PTA, CSST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 MURIEL ST NE
ALBUQUERQUE NM
87112-4440
US

IV. Provider business mailing address

1605 MURIEL ST NE
ALBUQUERQUE NM
87112-4440
US

V. Phone/Fax

Practice location:
  • Phone: 505-417-4338
  • Fax:
Mailing address:
  • Phone: 505-417-4338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0698
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA-0783
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: