Provider Demographics
NPI:1841401528
Name:WADE, KEITH ALAN (MPT)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:ALAN
Last Name:WADE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-2004
Mailing Address - Country:US
Mailing Address - Phone:617-244-2608
Mailing Address - Fax:
Practice Address - Street 1:142 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-2004
Practice Address - Country:US
Practice Address - Phone:617-244-2608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10836225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist