Provider Demographics
NPI:1467770362
Name:KECK, JOHN M (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:KECK
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 1:55 EHRBAR AVE # 1A
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-2444
Mailing Address - Country:US
Mailing Address - Phone:914-667-2996
Mailing Address - Fax:
Practice Address - Street 1:55 EHRBAR AVE # 1A
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-2444
Practice Address - Country:US
Practice Address - Phone:914-667-2996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0076992251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics