Provider Demographics
NPI:1033246921
Name:MCKEEVER, RUSSELL DEAN (PT)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:DEAN
Last Name:MCKEEVER
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 1:2401 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-5545
Mailing Address - Country:US
Mailing Address - Phone:325-698-8822
Mailing Address - Fax:
Practice Address - Street 1:3305 N 3RD ST
Practice Address - Street 2:SUITE 320
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603-7053
Practice Address - Country:US
Practice Address - Phone:325-672-6135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1123164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist