Provider Demographics
NPI:1184872616
Name:CRONIN, KEITH J (PT)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:J
Last Name:CRONIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 DUNN RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6762
Mailing Address - Country:US
Mailing Address - Phone:314-839-0002
Mailing Address - Fax:314-839-5994
Practice Address - Street 1:3501 DUNN RD
Practice Address - Street 2:SUITE 108
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-6762
Practice Address - Country:US
Practice Address - Phone:314-839-0002
Practice Address - Fax:314-839-5994
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8175225100000X
MO2009000182225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4209433OtherBLUECROSS BLUESHIELD
TN1509730Medicaid
TN3650200Medicare PIN