Provider Demographics
NPI:1720201932
Name:HAVEMEYER, KEITH S (PT, OCS, FAAOMPT)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:S
Last Name:HAVEMEYER
Suffix:
Gender:M
Credentials:PT, OCS, FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 CHASE AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06704-1904
Mailing Address - Country:US
Mailing Address - Phone:860-250-4369
Mailing Address - Fax:
Practice Address - Street 1:550 CHASE AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-1904
Practice Address - Country:US
Practice Address - Phone:860-250-4369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist