Provider Demographics
NPI:1104178714
Name:COY, KEITH ROBERT (DPT)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:ROBERT
Last Name:COY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 RIDGE AVE UNIT 26
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1064
Mailing Address - Country:US
Mailing Address - Phone:215-850-3526
Mailing Address - Fax:
Practice Address - Street 1:9001 RIDGE AVE UNIT 26
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1064
Practice Address - Country:US
Practice Address - Phone:215-850-3526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10192225100000X
DEJ1-0014449225100000X
PAPT0214832251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist