Provider Demographics
NPI:1629055090
Name:WEBSTER, KEITH J (ATC)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:J
Last Name:WEBSTER
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Gender:M
Credentials:ATC
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Mailing Address - Street 1:136 SPORTS CENTER DRIVE
Mailing Address - Street 2:EJ NUTTER TRAINING FACILITY
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40506-0001
Mailing Address - Country:US
Mailing Address - Phone:859-257-6521
Mailing Address - Fax:859-257-8953
Practice Address - Street 1:136 SPORTS CENTER DRIVE
Practice Address - Street 2:EJ NUTTER TRAINING FACILITY
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40506-0001
Practice Address - Country:US
Practice Address - Phone:859-257-6521
Practice Address - Fax:859-257-8953
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer