Provider Demographics
NPI:1508319252
Name:KEITH, KARA (PT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:KEITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 PATE ORR RD S
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-1400
Mailing Address - Country:US
Mailing Address - Phone:817-337-0162
Mailing Address - Fax:817-337-0235
Practice Address - Street 1:110 PATE ORR RD S
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-1400
Practice Address - Country:US
Practice Address - Phone:817-337-0162
Practice Address - Fax:817-337-0235
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1277845225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist