Provider Demographics
NPI:1417948100
Name:OHARA, KEITH (PT)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:OHARA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 JEAN AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1740
Mailing Address - Country:US
Mailing Address - Phone:978-851-8768
Mailing Address - Fax:978-851-8606
Practice Address - Street 1:10 JEAN AVE STE 10
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1740
Practice Address - Country:US
Practice Address - Phone:978-441-9452
Practice Address - Fax:978-454-9292
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA10193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68055Medicare PIN