Provider Demographics
NPI:1669407433
Name:KEITZER, NICHOLAS RAINES (DPT)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:RAINES
Last Name:KEITZER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6 WOMACK CT
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-2029
Mailing Address - Country:US
Mailing Address - Phone:808-780-6013
Mailing Address - Fax:
Practice Address - Street 1:165 ROWLAND WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5038
Practice Address - Country:US
Practice Address - Phone:415-898-1311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT330810Medicare PIN