Provider Demographics
NPI:1508264144
Name:HAUSMAN, KEITH (PT)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:
Last Name:HAUSMAN
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:PO BOX 541
Mailing Address - Street 2:
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-0541
Mailing Address - Country:US
Mailing Address - Phone:423-784-4704
Mailing Address - Fax:423-784-1865
Practice Address - Street 1:980 LONE RD
Practice Address - Street 2:
Practice Address - City:PIONEER
Practice Address - State:TN
Practice Address - Zip Code:37847-4236
Practice Address - Country:US
Practice Address - Phone:423-784-4704
Practice Address - Fax:423-784-1865
Is Sole Proprietor?:No
Enumeration Date:2014-12-14
Last Update Date:2014-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000000900225100000X
KYPT001043225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist