Provider Demographics
NPI:1699853671
Name:KEAT, MEAGAN (PT)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:KEAT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-6717
Mailing Address - Country:US
Mailing Address - Phone:248-853-5853
Mailing Address - Fax:
Practice Address - Street 1:555 BARCLAY CIR STE 110
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4574
Practice Address - Country:US
Practice Address - Phone:248-853-5853
Practice Address - Fax:248-853-5928
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236646Medicare ID - Type Unspecified