Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT-003352 | KY |
N | 2251S0007X | Physical Therapist - Sports | PT-003352 | KY |
N | 2251X0800X | Physical Therapist - Orthopedic | PT-003352 | KY |
NPI | 1114099330 |
---|---|
Provider Name | Keith Andrew Duerler |
First Address | Lexington, KY 40504-3756 |
Second Address | Lexington, KY 40504-3756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 02/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36000818 | ASC MEDICAID GROUP (01) | KY |
37903705 | MEDICAID LAB GROUP (01) | KY |
4000501 | MEDICARE LAB GROUP (01) | KY |
ASC1019 | ASC MEDICARE GROUP (01) | KY |
CB5773 | RR GROUP (01) | KY |
P00224418 | RR MEDICARE PIN (01) | KY |
S83561 | (02) | KY |