Provider Demographics
NPI:1295851988
Name:KEITH, MAUREEN C (PT)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:C
Last Name:KEITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:90 DOGWOOD DR
Mailing Address - Street 2:APT 101
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-7544
Mailing Address - Country:US
Mailing Address - Phone:401-691-4511
Mailing Address - Fax:
Practice Address - Street 1:660 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2707
Practice Address - Country:US
Practice Address - Phone:401-691-4511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02038225100000X
CT2355225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist