Provider Demographics
NPI:1427223353
Name:PACIFIC, KEITH
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:PACIFIC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2964 LOWELL CT
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5881
Mailing Address - Country:US
Mailing Address - Phone:321-972-8685
Mailing Address - Fax:407-241-2868
Practice Address - Street 1:2964 LOWELL CT
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5881
Practice Address - Country:US
Practice Address - Phone:321-972-8685
Practice Address - Fax:407-241-2868
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030135225100000X
FLPT24790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist