Provider Demographics
NPI:1811066574
Name:KEATING, AMY CARLISLE (PT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CARLISLE
Last Name:KEATING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 WOODSTOCK RD STE 310
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2220
Mailing Address - Country:US
Mailing Address - Phone:770-998-6636
Mailing Address - Fax:770-998-6646
Practice Address - Street 1:930 WOODSTOCK RD STE 310
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2220
Practice Address - Country:US
Practice Address - Phone:770-998-6636
Practice Address - Fax:770-998-6646
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0087744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT0087744OtherSTATE LISC NUMBER