Provider Demographics
NPI:1144209065
Name:KEIM, CURT E (PT)
Entity Type:Individual
Prefix:
First Name:CURT
Middle Name:E
Last Name:KEIM
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 1:1440 W WALNUT ST
Mailing Address - Street 2:#2
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1143
Mailing Address - Country:US
Mailing Address - Phone:217-245-1455
Mailing Address - Fax:217-243-6903
Practice Address - Street 1:1440 W WALNUT ST
Practice Address - Street 2:#2
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-1143
Practice Address - Country:US
Practice Address - Phone:217-245-1455
Practice Address - Fax:217-243-6903
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070002304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1945543OtherUNITED HEALTH CARE
IL216653OtherGROUP PTAN
IL216653OtherGROUP PTAN
IL0179880001Medicare NSC
ILK51511Medicare PIN