Provider Demographics
NPI:1609113398
Name:SEARS, KEITH S (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:S
Last Name:SEARS
Suffix:
Gender:M
Credentials:MS, ATC, LAT
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 405
Mailing Address - Street 2:317 N 3RD ST
Mailing Address - City:SHEFFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:50475-0405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:317 N 3RD ST
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:IA
Practice Address - Zip Code:50475-7716
Practice Address - Country:US
Practice Address - Phone:641-812-0872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer