Provider Demographics
NPI:1508996190
Name:KEEFE, BARBARA ANN AUG (DPT)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ANN AUG
Last Name:KEEFE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N3528 CALDWELL RD
Mailing Address - Street 2:
Mailing Address - City:SHELL LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54871-8788
Mailing Address - Country:US
Mailing Address - Phone:715-645-2198
Mailing Address - Fax:715-939-1557
Practice Address - Street 1:1280 CHANDLER DR
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-2202
Practice Address - Country:US
Practice Address - Phone:715-635-2111
Practice Address - Fax:715-939-1557
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4364024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40364400Medicaid