1215028568 NPI number — MINDY ANN KEATOR OTR

Table of content: KILEY WOMACK LMT (NPI 1134871346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215028568 NPI number — MINDY ANN KEATOR OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEATOR
Provider First Name:
MINDY
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215028568
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 STATE ST
Provider Second Line Business Mailing Address:
REHABILITATION TODAY
Provider Business Mailing Address City Name:
BRADFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16701-1122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-368-5648
Provider Business Mailing Address Fax Number:
814-368-2245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 E STATE ST.
Provider Second Line Business Practice Location Address:
GENESIS REHABILITATION SERVICES
Provider Business Practice Location Address City Name:
KENNETT SQUARE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-368-5648
Provider Business Practice Location Address Fax Number:
814-368-4522
Provider Enumeration Date:
09/28/2006

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: 225X00000X , with the licence number:  013012 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: OC008798 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00011264701 . This is a "UNIVERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000670162001 . This is a "WNYBCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1699692 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 22361607 . This is a "MPN EMPIRE PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001547543 . This is a "KEYSTONE SELECT BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02532543 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100847694 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 175626062 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 22361607 . This is a "NORTH AMERICAN HEALTH PLA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223616077 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223616077 . This is a "INTER GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223616077 . This is a "NOVA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223616077 . This is a "FIDELIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 240033 . This is a "HEALTH AMERICA" identifier . This identifiers is of the category "OTHER".




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