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NPI Code Detail

MEDICARE: KEITH ALAN DAVIS

MEDICARE:   KEITH ALAN DAVIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist110258MO

General Provider Information

NPI Number : 1902130172
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEITH ALAN DAVIS
Provider Business Mailing Address
First Line : 10206 AUDRAIN ROAD 997
Second Line :
City : CENTRALIA
State : MO
Zip : 65240-6354
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 200 SOUTH ST
Second Line :
City : PARIS
State : MO
Zip : 65275-1165
Country : US
Telephone Number : 660-327-4125
Fax Number : 660-327-1024
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2009
Last Update Date : 09/22/2009

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Directions to “ KEITH ALAN DAVIS ” Practice Location

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