Provider Demographics
NPI:1457884421
Name:KEITH, BRYAN (DPT)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:KEITH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:112 BRADFORD BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:GORDONSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38563-4617
Mailing Address - Country:US
Mailing Address - Phone:615-683-3010
Mailing Address - Fax:615-983-3016
Practice Address - Street 1:320 W BUTLER RD
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2538
Practice Address - Country:US
Practice Address - Phone:865-225-7300
Practice Address - Fax:865-225-7301
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN11382225100000X
SC84972081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist