Provider Demographics
NPI:1619000759
Name:KEITH ROPER AND ASSOCIATES INC.
Entity Type:Organization
Organization Name:KEITH ROPER AND ASSOCIATES INC.
Other - Org Name:INTERMOUNTAIN PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:ROPER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:530-335-3206
Mailing Address - Street 1:37116 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BURNEY
Mailing Address - State:CA
Mailing Address - Zip Code:96013-4127
Mailing Address - Country:US
Mailing Address - Phone:530-335-3206
Mailing Address - Fax:530-335-5383
Practice Address - Street 1:37116 MAIN ST
Practice Address - Street 2:
Practice Address - City:BURNEY
Practice Address - State:CA
Practice Address - Zip Code:96013-4127
Practice Address - Country:US
Practice Address - Phone:530-335-3206
Practice Address - Fax:530-335-5383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15505225100000X
CAPT33915225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0155050Medicaid
CAPT0155050Medicaid