Provider Demographics
NPI:1245537349
Name:NORMAN, KEELY RENEE (PT, DPT, MTC)
Entity type:Individual
Prefix:DR
First Name:KEELY
Middle Name:RENEE
Last Name:NORMAN
Suffix:
Gender:F
Credentials:PT, DPT, MTC
Other - Prefix:
Other - First Name:KEELY
Other - Middle Name:RENEE
Other - Last Name:HAIRSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:2603 W PLEASANT GROVE RD STE 104
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8514
Practice Address - Country:US
Practice Address - Phone:479-636-1187
Practice Address - Fax:479-636-1197
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 3336225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist