Provider Demographics
NPI:1639129463
Name:KECK, ROBERT ERNEST (MSPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ERNEST
Last Name:KECK
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7827225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC010825807OtherHEALTH CARE SAVINGS
NC078VPOtherBLUE CROSS/BLUE SHIELD-NC
NC2114294OtherFIRST HEALTH
NC2503952AMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE
NC2114294OtherFIRST HEALTH