Provider Demographics
NPI:1013366152
Name:YEARWOOD, KEATON T (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:KEATON
Middle Name:T
Last Name:YEARWOOD
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HAYES ST
Mailing Address - Street 2:PO BOX 399
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-2696
Mailing Address - Country:US
Mailing Address - Phone:706-886-3883
Mailing Address - Fax:706-886-3812
Practice Address - Street 1:22 HAYES ST
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-2696
Practice Address - Country:US
Practice Address - Phone:706-886-3883
Practice Address - Fax:706-886-3812
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012355225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist