Provider Demographics
NPI:1376145953
Name:KEITH, HAMILTON (PT)
Entity Type:Individual
Prefix:
First Name:HAMILTON
Middle Name:
Last Name:KEITH
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 1:1115 BOULDERS PARKWAY, SUITE 200
Mailing Address - Street 2:SUITE 200
Mailing Address - City:N CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-3206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:804-968-1803
Practice Address - Street 1:13801 ST FRANCIS BOULEVARD
Practice Address - Street 2:SUITE 200
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3206
Practice Address - Country:US
Practice Address - Phone:804-285-2645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213867225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist