Healthcare Provider Details

I. General information

NPI: 1245943539
Provider Name (Legal Business Name): ANNETTE ALYSON KEFFER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 01/02/2023
Certification Date: 01/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 AUTUMN PARK WAY
MECHANICSVILLE VA
23116-3868
US

IV. Provider business mailing address

14200 SAPPHIRE PARK LN APT 101
MIDLOTHIAN VA
23114-5326
US

V. Phone/Fax

Practice location:
  • Phone: 804-730-0009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2305214605
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: