Provider Demographics
NPI:1598720310
Name:KECK PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:KECK PHYSICAL THERAPY INC
Other - Org Name:KECK PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:KECK
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT
Authorized Official - Phone:828-890-4905
Mailing Address - Street 1:271 OLD BARN RD STE C
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-8406
Mailing Address - Country:US
Mailing Address - Phone:828-890-4905
Mailing Address - Fax:828-890-2371
Practice Address - Street 1:271 OLD BARN RD STE C
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-8406
Practice Address - Country:US
Practice Address - Phone:828-890-4905
Practice Address - Fax:828-890-8123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7827261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC078VPOtherBCBS
2114294OtherFIRST HEALTH
NC7211449Medicaid
NC7211449Medicaid
NC7211449Medicaid