MEDICARE: MRS. ELIZABETH A KEITH PT, PCS

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
1	225100000X	Physical Therapist	0009497	FL
2	2251P0200X	Pediatric Physical Therapist	009497	FL
3	222Q00000X	Developmental Therapist	009497	FL

General Provider Information

NPI Number	:	1912944224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH A KEITH PT, PCS

Provider Business Mailing Address
First Line	:	5790 WHIRLAWAY RD
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-7738
Country	:	US
Telephone Number	:	561-625-6860
Fax Number	:	561-625-6859

Provider Business Practice Location Address
First Line	:	4362 NORTHLAKE BLVD
Second Line	:	SUITE 105
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-6275
Country	:	US
Telephone Number	:	561-625-6860
Fax Number	:	561-625-6859

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	03/22/2011

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