Healthcare Provider Details

I. General information

NPI: 1609356302
Provider Name (Legal Business Name): JOSIE KEFFELER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 CUPPLES RD
SAN ANTONIO TX
78237-4328
US

IV. Provider business mailing address

10115 SAHARA ST APT 702
SAN ANTONIO TX
78216-3808
US

V. Phone/Fax

Practice location:
  • Phone: 210-434-0611
  • Fax:
Mailing address:
  • Phone: 402-201-5832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2052263
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number648
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: