Provider Demographics
NPI:1033176003
Name:REAGAN, KEITH MICHAEL (PT)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:MICHAEL
Last Name:REAGAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 S UNION AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1953
Mailing Address - Country:US
Mailing Address - Phone:253-627-7012
Mailing Address - Fax:253-627-7014
Practice Address - Street 1:1818 S UNION AVE STE 1B
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1953
Practice Address - Country:US
Practice Address - Phone:253-627-7012
Practice Address - Fax:253-627-7014
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA8422225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist