Individual
KEATON S GROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
25 HERITAGE WAY, KALISPELL, MT 59901-3100
(406) 752-3597
Mailing address
25 HERITAGE WAY, KALISPELL, MT 59901-3100
(406) 407-7990
(855) 928-0774
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
24311
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTP-PT-LIC-24311
ST OF MT BUSINESS STANDARDS DIV BOARD OF PT EXAMINERS
MT
Enumeration date
05/18/2022
Last updated
05/18/2022
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