Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 070.006123 | IL |
NPI | 1114375797 |
---|---|
Provider Name | Dr. Raquel Keithley |
First Address | Gray, TN 37615-4298 |
Second Address | Johnson City, TN 37604-6035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2016 |
Last Update Date | 24/05/2016 |