Provider Demographics
NPI:1801082011
Name:KEEL, LAUREN (PTA, ATC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:KEEL
Suffix:
Gender:F
Credentials:PTA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 S ALMA SCHOOL RD
Mailing Address - Street 2:#101
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-3757
Mailing Address - Country:US
Mailing Address - Phone:480-782-7831
Mailing Address - Fax:
Practice Address - Street 1:3200 S ALMA SCHOOL RD
Practice Address - Street 2:#101
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-3757
Practice Address - Country:US
Practice Address - Phone:480-782-7831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10566A225200000X
AZ05762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ036551Medicare UPIN