Provider Demographics
NPI:1447460829
Name:KEITH, PEGGY RUTH (PT)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:RUTH
Last Name:KEITH
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 1:4856 E 148TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-4071
Mailing Address - Country:US
Mailing Address - Phone:918-366-0906
Mailing Address - Fax:
Practice Address - Street 1:ST FRANCIS
Practice Address - Street 2:6161 S YALE AVE
Practice Address - City:TULSA
Practice Address - State:OR
Practice Address - Zip Code:74136
Practice Address - Country:US
Practice Address - Phone:918-494-1471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist