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General NPI Number Information
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NPI Number | 1700975869
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Entity Type | Individual
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Provider Name | BRIAN EDWARD KEYES M.P.T.
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 02/22/2022
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Provider Practice Location Address
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Address Line | 6770 DIXIE HWY STE 104
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City | CLARKSTON
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State | MI
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Zip | 48346-2088
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Country | US
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Telephone | 248-625-9466
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Fax |
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Provider Business Mailing Address
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Address Line | 6124 VALERIAN CT
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City | GRAND BLANC
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State | MI
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Zip | 48439-2325
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Country | US
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Telephone | 810-953-5353
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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 | 5501009290
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License Number State | MI
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