Healthcare Provider Details

I. General information

NPI: 1730567975
Provider Name (Legal Business Name): KATELYN KEITH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 WITTINGTON PL SUITE #175
DALLAS TX
75234-1927
US

IV. Provider business mailing address

2442 TONGASS AVE
KETCHIKAN AK
99901-5928
US

V. Phone/Fax

Practice location:
  • Phone: 866-221-5405
  • Fax: 866-534-5697
Mailing address:
  • Phone: 907-225-7808
  • Fax: 907-247-7868

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: