Healthcare Provider Details

I. General information

NPI: 1700711371
Provider Name (Legal Business Name): KEYSTONE MODIFICATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MORRIS RD
FORT WASHINGTON PA
19034-2003
US

IV. Provider business mailing address

200 W BUTLER AVE UNIT 73
AMBLER PA
19002-5756
US

V. Phone/Fax

Practice location:
  • Phone: 215-273-6399
  • Fax: 215-273-6440
Mailing address:
  • Phone: 215-273-6399
  • Fax: 215-273-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. GABRIELLE MINICH
Title or Position: OWNER
Credential: PT, DPT, CAPS
Phone: 215-273-6399