MEDICARE: JANELLE KEIFER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	11327	AZ
2	225100000X	Physical Therapist	60571052	WA

General Provider Information

NPI Number	:	1437528890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANELLE KEIFER

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:
Fax Number	:	517-435-3670

Provider Business Practice Location Address
First Line	:	3018 FESTIVAL WAY UNIT 323
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20601-2958
Country	:	US
Telephone Number	:	240-754-5520
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2015
Last Update Date	:	08/16/2024

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Directions to “ JANELLE KEIFER ” Practice Location

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