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General NPI Number Information
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NPI Number | 1578725925
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Entity Type | Organization
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Legal Business Name | DALE KEYWORTH PT PC
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Dates
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Enumeration Date | 06/26/2008
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Last Update Date | 12/02/2010
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Provider Practice Location Address
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Address Line | 5320 DORA ST
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City | HOUSTON
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State | TX
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Zip | 77005-1818
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Country | US
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Telephone | 713-523-9482
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Fax | 713-523-9486
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Provider Business Mailing Address
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Address Line | 5320 DORA ST
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City | HOUSTON
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State | TX
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Zip | 77005-1818
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Country | US
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Telephone | 713-523-9482
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Fax | 713-523-9486
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Authorized Official
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Title or Position | CEO
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Name | DALE B KEYWORTH
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Credential | PT, M ED
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Telephone | 713-516-1443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1009843
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License Number State | TX
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