Provider Demographics
NPI:1851828503
Name:KEITA, MEGHAN (DPT, PT)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:KEITA
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-8930
Mailing Address - Fax:423-954-7399
Practice Address - Street 1:1 SHERIDAN SQ
Practice Address - Street 2:STE100
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7391
Practice Address - Country:US
Practice Address - Phone:423-230-0194
Practice Address - Fax:423-230-0216
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist