Provider Demographics
NPI:1336755495
Name:KEYS, KEVIN (MS, ATC LAT, PES)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:KEYS
Suffix:
Gender:M
Credentials:MS, ATC LAT, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 TOMAHAWK DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-6606
Mailing Address - Country:US
Mailing Address - Phone:239-938-4334
Mailing Address - Fax:
Practice Address - Street 1:106 TOMAHAWK DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-6606
Practice Address - Country:US
Practice Address - Phone:239-938-4334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000028022OtherBOARD OF CERTIFICATION