Basic Information
Provider Information
NPI: 1669641999
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KEEFER
FirstName: BRETT
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1769
Address2:  
City: MIDDLEBURG
State: VA
PostalCode: 201181769
CountryCode: US
TelephoneNumber: 5406878181
FaxNumber: 5406878256
Practice Location
Address1: 8250 GREENSBORO DR
Address2:  
City: MC LEAN
State: VA
PostalCode: 221024902
CountryCode: US
TelephoneNumber: 7033880288
FaxNumber: 7033880290
Other Information
ProviderEnumerationDate: 02/20/2008
LastUpdateDate: 05/22/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X2305205298VAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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