Provider Demographics
NPI:1700894458
Name:STROUD, KEITH H (PT)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:H
Last Name:STROUD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-2316
Mailing Address - Country:US
Mailing Address - Phone:903-885-0108
Mailing Address - Fax:
Practice Address - Street 1:2544 MANGUM ST
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:TX
Practice Address - Zip Code:75428-3515
Practice Address - Country:US
Practice Address - Phone:903-886-7669
Practice Address - Fax:903-886-7679
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056505225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84630TOtherBCBS PROVIDER
TX83242EMedicare ID - Type UnspecifiedMEDICARE PART B