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General NPI Number Information
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NPI Number | 1194760371
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Entity Type | Individual
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Provider Name | KEITH WADE PESNELL P.T.
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Gender | Male
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 04/21/2021
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Provider Practice Location Address
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Address Line | 2327 W HIGHWAY 35
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City | ANGLETON
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State | TX
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Zip | 77515-7455
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Country | US
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Telephone | 979-848-1886
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Fax | 979-848-1376
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Provider Business Mailing Address
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Address Line | 421 S VELASCO ST
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City | ANGLETON
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State | TX
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Zip | 77515-6015
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Country | US
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Telephone | 979-848-1886
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Fax | 979-848-1376
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1090983
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License Number State | TX
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