Healthcare Provider Details

I. General information

NPI: 1962857508
Provider Name (Legal Business Name): KEISHA HAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 PENNKNOLL RD
EVERETT PA
15537-6940
US

IV. Provider business mailing address

1601 MAIN ST
BERLIN PA
15530-1438
US

V. Phone/Fax

Practice location:
  • Phone: 814-623-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE010922
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: