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General NPI Number Information
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NPI Number | 1801207667
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Entity Type | Individual
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Provider Name | DAVID ANDREW KECK PTA
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Gender | Male
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 05/14/2014
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Provider Practice Location Address
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Address Line | 3801 JOHNSON MILL BLVD STE B
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City | FAYETTEVILLE
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State | AR
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Zip | 72704-6364
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Country | US
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Telephone | 479-856-6400
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Fax | 479-856-6623
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Provider Business Mailing Address
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Address Line | 17162 MISTY WOOD RD
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City | WEST FORK
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State | AR
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Zip | 72774-2840
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Country | US
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Telephone | 479-236-2389
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA 2677
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License Number State | AR
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