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General NPI Number Information
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NPI Number | 1366402232
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Entity Type | Individual
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Provider Name | KENNETH S. KEISTER ATC,
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2500 W TAFT VINELAND RD
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City | ORLANDO
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State | FL
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Zip | 32837-7818
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Country | US
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Telephone | 407-816-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 1451 SOUTHWIND DR
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City | CASSELBERRY
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State | FL
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Zip | 32707-5154
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Country | US
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Telephone | 407-256-8485
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2255A2300X
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License Number State | FL
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