Provider Demographics
NPI:1114132560
Name:KEACH, KENNETH LUKE (PT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:LUKE
Last Name:KEACH
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 1:6025 LEE HWY STE 445
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2966
Mailing Address - Country:US
Mailing Address - Phone:423-499-4043
Mailing Address - Fax:423-499-4045
Practice Address - Street 1:6025 LEE HWY STE 445
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2966
Practice Address - Country:US
Practice Address - Phone:423-499-4043
Practice Address - Fax:423-499-4045
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9099225100000X
TNPT0000007556225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist