Provider Demographics
NPI:1497389936
Name:PHIPPS, KEITH ALLEN (PTA)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:ALLEN
Last Name:PHIPPS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 FERNDALE APARTMENTS RD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977-8578
Mailing Address - Country:US
Mailing Address - Phone:606-337-7071
Mailing Address - Fax:606-337-1364
Practice Address - Street 1:39 FERNDALE APARTMENTS RD
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-8578
Practice Address - Country:US
Practice Address - Phone:606-337-7071
Practice Address - Fax:606-337-1364
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2024-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA03988225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant