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Individual
KEITH R SALES
Active
Individual
KEITH R SALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
P13210
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
165FX
BCBSNC
NC
05
—
7212894
—
NC
Enumeration date
07/01/2011
Last updated
12/13/2018
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