Provider Demographics
NPI:1942597323
Name:ROED, KEITH (PT, DPT, CMPT)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:ROED
Suffix:
Gender:M
Credentials:PT, DPT, CMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4295 SERGEANT RD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4625
Mailing Address - Country:US
Mailing Address - Phone:712-560-0460
Mailing Address - Fax:712-560-4137
Practice Address - Street 1:4295 SERGEANT RD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106
Practice Address - Country:US
Practice Address - Phone:712-560-0460
Practice Address - Fax:712-560-4137
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1811225100000X
IA004816225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist