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General NPI Number Information
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NPI Number | 1508461617
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Entity Type | Individual
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Provider Name | KEITH CREAGH DPT
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Gender | Male
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Dates
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Enumeration Date | 12/04/2020
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Last Update Date | 12/04/2020
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Provider Practice Location Address
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Address Line | 113 ROUTE 73
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City | VOORHEES
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State | NJ
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Zip | 08043-9573
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Country | US
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Telephone | 856-809-3559
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Fax |
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Provider Business Mailing Address
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Address Line | 195 RAMBLEWOOD PKWY
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City | MOUNT LAUREL
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State | NJ
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Zip | 08054-2325
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Country | US
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Telephone | 215-749-2553
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01490700
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License Number State | NJ
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