Provider Demographics
NPI:1538223367
Name:KEATING, HEATHER SUZANNE (PT)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:SUZANNE
Last Name:KEATING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 W SHERMAN WAY SUITE 1
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714
Mailing Address - Country:US
Mailing Address - Phone:417-725-2728
Mailing Address - Fax:417-595-4891
Practice Address - Street 1:106 W SHERMAN WAY SUITE 1
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714
Practice Address - Country:US
Practice Address - Phone:417-725-2728
Practice Address - Fax:417-595-4891
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006035008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO266644Medicare ID - Type Unspecified