Provider Demographics
NPI:1568237881
Name:HUGHES, KEITH JAMIL (LMT)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:JAMIL
Last Name:HUGHES
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 KENILWORTH TER NE APT 619
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-1520
Mailing Address - Country:US
Mailing Address - Phone:862-321-9910
Mailing Address - Fax:
Practice Address - Street 1:1170 22ND ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1219
Practice Address - Country:US
Practice Address - Phone:202-974-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019018572225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist