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NPI Code Detail

MEDICARE: KEATON DIR DPT

MEDICARE: KEATON DIR DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1073245171
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEATON DIR DPT
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number : 866-370-8206
Fax Number : 517-435-3670
Provider Business Practice Location Address
First Line : 1245 MAIN ST STE 230
Second Line :
City : BUDA
State : TX
Zip : 78610-2269
Country : US
Telephone Number : 512-400-4437
Fax Number : 512-572-7802
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2022
Last Update Date : 04/15/2025

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Directions to “ KEATON DIR DPT” Practice Location

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