1073733838 NPI number — MR. ERIC RICHARD KEIPER PHYSICAL THERAPIST

Table of content: MR. ERIC RICHARD KEIPER PHYSICAL THERAPIST (NPI 1073733838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073733838 NPI number — MR. ERIC RICHARD KEIPER PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEIPER
Provider First Name:
ERIC
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KEIPER
Provider Other First Name:
ERIC
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1073733838
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
609 W 40TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAND SPRINGS
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74063-2665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-691-6788
Provider Business Mailing Address Fax Number:
918-514-4437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
609 W 40TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAND SPRINGS
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74063-2665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-691-6788
Provider Business Practice Location Address Fax Number:
918-514-4437
Provider Enumeration Date:
04/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  4486 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)