Provider Demographics
NPI:1700361664
Name:KEITH, WILLIAM AUSTIN (PTA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:AUSTIN
Last Name:KEITH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-5325
Mailing Address - Country:US
Mailing Address - Phone:870-246-8623
Mailing Address - Fax:870-246-8694
Practice Address - Street 1:3030 PINE ST
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-5325
Practice Address - Country:US
Practice Address - Phone:870-246-8623
Practice Address - Fax:870-246-8694
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA4087225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant