Provider Demographics
NPI:1578725925
Name:DALE KEYWORTH PT PC
Entity Type:Organization
Organization Name:DALE KEYWORTH PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:B
Authorized Official - Last Name:KEYWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, M ED
Authorized Official - Phone:713-516-1443
Mailing Address - Street 1:5320 DORA ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1818
Mailing Address - Country:US
Mailing Address - Phone:713-523-9482
Mailing Address - Fax:713-523-9486
Practice Address - Street 1:5320 DORA ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1818
Practice Address - Country:US
Practice Address - Phone:713-523-9482
Practice Address - Fax:713-523-9486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1009843261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1134102148OtherINDIVIDUAL NPI
TX1009843OtherPHYSICAL THERAPIST LICENSE NUMBER
TX1009843OtherPHYSICAL THERAPIST LICENSE NUMBER