| Doctor Name: | MR. MAIKUTLO B KEBAETSE |
| NPI Number: | 1326190653 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D, P.T. |
| License Number: | 40QA00685900 |
| Business Practice Address: | 541 Mantua Ave Paulsboro, NJ - 080661178 |
| Business Phone Number: | 1856224000 |
| Business Fax Number: | 8562240466 |
| Mailing Address: | Po Box 277, PAULSBORO |
| State: | NJ |
| Postal Code: | 080660277 |
| Phone Number: | 1856220400 |
| Fax Number: | 8562240466 |
| NPI Enumeration Date: | 01/17/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 40QA00685900 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |