Individual
MR. PHILIP ANTHONY KEITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1001 E BELTLINE AVE NE, GRAND RAPIDS, MI 49525-5803
(616) 831-7006
(616) 222-1542
Mailing address
23 N LINCOLN ST, ROCKFORD, MI 49341-1311
(616) 863-0957
(616) 222-1542
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
07/04/2006
Last updated
07/08/2007
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