Provider Demographics
NPI:1801343579
Name:PLANT, KEIOSHA
Entity type:Individual
Prefix:
First Name:KEIOSHA
Middle Name:
Last Name:PLANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28268C HIGHWAY 405
Mailing Address - Street 2:
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-7900
Mailing Address - Country:US
Mailing Address - Phone:225-205-1227
Mailing Address - Fax:
Practice Address - Street 1:58725 BELLEVIEW DR
Practice Address - Street 2:SUITE A-7
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-3948
Practice Address - Country:US
Practice Address - Phone:225-205-1227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA4929-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist