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General NPI Number Information
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NPI Number | 1922089168
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Entity Type | Organization
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Legal Business Name | KEITHLY REHAB PLLC
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Dates
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Enumeration Date | 11/06/2005
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Last Update Date | 09/22/2008
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Provider Practice Location Address
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Address Line | 522 W BROADWAY AVE
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City | ENID
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State | OK
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Zip | 73701-3842
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Country | US
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Telephone | 580-237-0905
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Fax | 580-237-0948
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Provider Business Mailing Address
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Address Line | 522 W BROADWAY AVE
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City | ENID
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State | OK
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Zip | 73701-3842
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Country | US
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Telephone | 580-237-0905
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Fax | 580-237-0948
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Authorized Official
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Title or Position | PHYSCIAL THERAPIST
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Name | MR. KENT ALLEN KEITHLY
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Credential | RPT
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Telephone | 580-237-0905
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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 | 3690
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License Number State | OK
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