Provider Demographics
NPI:1972525335
Name:STROTHER, KEITH R (PT)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:R
Last Name:STROTHER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19891 BEACH BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-3209
Mailing Address - Country:US
Mailing Address - Phone:714-536-9700
Mailing Address - Fax:714-536-9701
Practice Address - Street 1:19891 BEACH BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-3209
Practice Address - Country:US
Practice Address - Phone:714-536-9700
Practice Address - Fax:714-536-9701
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA135542251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT13554OtherLEGACY PIN
CAPT13554OtherLEGACY PIN