Healthcare Provider Details

I. General information

NPI: 1609113398
Provider Name (Legal Business Name): KEITH S SEARS MS, ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 N 3RD ST
SHEFFIELD IA
50475-7716
US

IV. Provider business mailing address

PO BOX 405 317 N 3RD ST
SHEFFIELD IA
50475-0405
US

V. Phone/Fax

Practice location:
  • Phone: 641-812-0872
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: