Provider Demographics
NPI:1780246710
Name:KEATON, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:KEATON
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 1:20113 43RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7319
Mailing Address - Country:US
Mailing Address - Phone:817-683-5858
Mailing Address - Fax:
Practice Address - Street 1:507 STATE ROUTE 2 STE E
Practice Address - Street 2:
Practice Address - City:SULTAN
Practice Address - State:WA
Practice Address - Zip Code:98294-9515
Practice Address - Country:US
Practice Address - Phone:360-799-0958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-29
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist