Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT009975 | GA |
NPI | 1063725216 |
---|---|
Provider Name | Mrs. Lauren Brooke Keeton |
First Address | Ft Oglethorpe, GA 30742-3126 |
Second Address | Ft. Oglethorpe, GA 30742 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2010 |
Last Update Date | 16/07/2010 |