Provider Demographics
NPI:1922177468
Name:TRAVERS, KEITH (PT, MTC)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:
Last Name:TRAVERS
Suffix:
Gender:M
Credentials:PT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1768
Mailing Address - Country:US
Mailing Address - Phone:773-755-7566
Mailing Address - Fax:
Practice Address - Street 1:2555 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1768
Practice Address - Country:US
Practice Address - Phone:773-755-7566
Practice Address - Fax:773-755-7580
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist