Healthcare Provider Details

I. General information

NPI: 1194640854
Provider Name (Legal Business Name): ELIZABETH KEEZER CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BRANDON AVE
CHARLOTTESVILLE VA
22903-3310
US

IV. Provider business mailing address

9594 WARREN FERRY RD
SCOTTSVILLE VA
24590-3858
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-2013
  • Fax:
Mailing address:
  • Phone: 434-960-2016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019013275
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: