Provider Demographics
NPI:1588644306
Name:GOOD, KEITH L (LPT)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:L
Last Name:GOOD
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 210
Mailing Address - Street 2:15050 KUTZTOWN RD
Mailing Address - City:KUTZTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19530
Mailing Address - Country:US
Mailing Address - Phone:610-683-5686
Mailing Address - Fax:610-683-8773
Practice Address - Street 1:600 HIGH BLVD
Practice Address - Street 2:
Practice Address - City:KENHORST
Practice Address - State:PA
Practice Address - Zip Code:19607
Practice Address - Country:US
Practice Address - Phone:610-796-9687
Practice Address - Fax:610-796-9391
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006367L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA530787OtherBLUE SHIELD
PA03119701OtherBLUE CROSS