Provider Demographics
NPI:1932676996
Name:KEATON, CLAIRE (PT)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:KEATON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 MEDICAL DR STE 109
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3825
Mailing Address - Country:US
Mailing Address - Phone:636-327-7240
Mailing Address - Fax:636-327-7249
Practice Address - Street 1:853 MEDICAL DR STE 109
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3825
Practice Address - Country:US
Practice Address - Phone:636-327-7240
Practice Address - Fax:636-327-7249
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016022566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist