Provider Demographics
NPI:1336152065
Name:REEBER, KEITH DANIEL (RPT)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:DANIEL
Last Name:REEBER
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2252 WAYCROSS RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-2743
Mailing Address - Country:US
Mailing Address - Phone:513-742-2333
Mailing Address - Fax:513-742-0943
Practice Address - Street 1:861 N NOB HILL RD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1076
Practice Address - Country:US
Practice Address - Phone:954-577-5705
Practice Address - Fax:954-577-0168
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY93157Medicare ID - Type Unspecified