Provider Demographics
NPI:1043238645
Name:GIRARD, KEITH ALLEN (PT)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:ALLEN
Last Name:GIRARD
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 1:6605 ABBEY RD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-9002
Mailing Address - Country:US
Mailing Address - Phone:918-331-9615
Mailing Address - Fax:918-333-1742
Practice Address - Street 1:3805 WASHINGTON PLACE
Practice Address - Street 2:SUITE B
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-9002
Practice Address - Country:US
Practice Address - Phone:918-333-1524
Practice Address - Fax:918-333-1742
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist