Physician Compare National (NPI:1114132560)

HEALTHCARE PROVIDER: KENNETH LUKE KEACH PT

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1114132560
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0749460491
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110531000103
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KEACH
	Individual professional last name
Provider First Name	KENNETH
	Individual professional first name
Provider Middle Name	LUKE
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2006
	Individual professional's medical school graduation year
Primary Specialty	PHYSICAL THERAPY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	6025 LEE HWY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 445
	Group Practice or individual's line 2 address
City	CHATTANOOGA
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	374212966
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y