Individual
KEITH DEAGOSTINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3072 W 300 N, SUITE A, WEST POINT, UT 84015-3933
(914) 623-8375
Mailing address
3072 W 300 N, SUITE A, WEST POINT, UT 84015-3933
(914) 623-8375
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
345428-2401
UT
261QP2000X
Physical Therapy Clinic/Center
345428-2401
UT
Other
Enumeration date
12/01/2009
Last updated
09/12/2011
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