Provider Demographics
NPI:1255304424
Name:GARNETT, KEITH (MS, ATC, LAT, PES)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:
Last Name:GARNETT
Suffix:
Gender:M
Credentials:MS, ATC, LAT, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 E REDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5172
Mailing Address - Country:US
Mailing Address - Phone:704-968-9734
Mailing Address - Fax:704-688-8725
Practice Address - Street 1:333 E TRADE ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2425
Practice Address - Country:US
Practice Address - Phone:704-688-8998
Practice Address - Fax:704-688-8726
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist