Provider Demographics
NPI:1215020482
Name:KEATON, NATHAN SCOTT (PT)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:SCOTT
Last Name:KEATON
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:PO BOX 4344
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37831-4344
Mailing Address - Country:US
Mailing Address - Phone:865-385-7782
Mailing Address - Fax:865-482-8222
Practice Address - Street 1:614 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-5154
Practice Address - Country:US
Practice Address - Phone:865-385-7782
Practice Address - Fax:865-482-8222
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN57482251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441549Medicaid