Basic Information
| Provider Information | |||||||||
| NPI: | 1063725216 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEETON | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | BROOKE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| OtherLastName: | KEETON | ||||||||
| OtherFirstName: | LAUREN | ||||||||
| OtherMiddleName: | BROOKE | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 118 HERRON ST | ||||||||
| Address2: | |||||||||
| City: | FT OGLETHORPE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307423126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068617471 | ||||||||
| FaxNumber: | 7068617472 | ||||||||
| Practice Location | |||||||||
| Address1: | 118 HERRON ST | ||||||||
| Address2: | |||||||||
| City: | FT. OGLETHORPE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068617471 | ||||||||
| FaxNumber: | 7068617472 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2010 | ||||||||
| LastUpdateDate: | 07/16/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251P0200X | PT009975 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
No ID Information.