Provider Demographics
NPI:1477040525
Name:GARVIN, KEITH
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:GARVIN
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 1:2621 CRABAPPLE CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-6640
Mailing Address - Country:US
Mailing Address - Phone:561-789-8953
Mailing Address - Fax:
Practice Address - Street 1:500 NE SPANISH RIVER BLVD STE 35
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4517
Practice Address - Country:US
Practice Address - Phone:561-789-8953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-15
Last Update Date:2018-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist