Healthcare Provider Details

I. General information

NPI: 1548313679
Provider Name (Legal Business Name): KEITH ROBERT ADAMS LMT, CRTT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 FORT MELLON CT
ST AUGUSTINE FL
32092-2446
US

IV. Provider business mailing address

2232 FORT MELLON CT
ST AUGUSTINE FL
32092-2446
US

V. Phone/Fax

Practice location:
  • Phone: 904-465-4046
  • Fax:
Mailing address:
  • Phone: 904-465-4046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA33269
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberTT8467
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: