Healthcare Provider Details

I. General information

NPI: 1093493546
Provider Name (Legal Business Name): KEISHA PERKINS PT, DPT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KEISHA JOHNSON

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9325 MIDLOTHIAN TPKE STE A
NORTH CHESTERFIELD VA
23235-4943
US

IV. Provider business mailing address

4054 HYDE PARK DR
CHESTER VA
23831-4823
US

V. Phone/Fax

Practice location:
  • Phone: 757-490-3223
  • Fax:
Mailing address:
  • Phone: 801-687-3513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305215816
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: