Provider Demographics
NPI:1578593711
Name:KEITH, PHILIP ANTHONY (ATC)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:ANTHONY
Last Name:KEITH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
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Mailing Address - Street 1:23 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1311
Mailing Address - Country:US
Mailing Address - Phone:616-863-0957
Mailing Address - Fax:616-222-1542
Practice Address - Street 1:1001 E BELTLINE AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-5803
Practice Address - Country:US
Practice Address - Phone:616-831-7006
Practice Address - Fax:616-222-1542
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer