Provider Demographics
NPI:1750625075
Name:ALLEN, KEITH EVAN
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:EVAN
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 GOULD AVE
Mailing Address - Street 2:42
Mailing Address - City:MEREDITH
Mailing Address - State:NH
Mailing Address - Zip Code:03253-6539
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23 GOULD AVE
Practice Address - Street 2:42
Practice Address - City:MEREDITH
Practice Address - State:NH
Practice Address - Zip Code:03253-6539
Practice Address - Country:US
Practice Address - Phone:603-289-0779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1025225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant