Provider Demographics
NPI:1912944224
Name:KEITH, ELIZABETH A (PT, PCS)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:A
Last Name:KEITH
Suffix:
Gender:F
Credentials:PT, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5790 WHIRLAWAY RD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-7738
Mailing Address - Country:US
Mailing Address - Phone:561-625-6860
Mailing Address - Fax:561-625-6859
Practice Address - Street 1:4362 NORTHLAKE BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6275
Practice Address - Country:US
Practice Address - Phone:561-625-6860
Practice Address - Fax:561-625-6859
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0009497225100000X
FL0094972251P0200X, 222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist