Provider Demographics
NPI:1417081787
Name:HATCH, KEITH M (PT)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:M
Last Name:HATCH
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 1:1623 WIESE LN.
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406
Mailing Address - Country:US
Mailing Address - Phone:262-886-2514
Mailing Address - Fax:
Practice Address - Street 1:1611 RENAISSANCE BLVD
Practice Address - Street 2:
Practice Address - City:STURTEVANT
Practice Address - State:WI
Practice Address - Zip Code:53177-1741
Practice Address - Country:US
Practice Address - Phone:262-886-2599
Practice Address - Fax:262-886-5767
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4359-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist