Individual
MR. KENT ALLEN KEITHLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
522 W BROADWAY AVE, ENID, OK 73701-3842
(580) 237-0905
(580) 237-0948
Mailing address
8025 N 30TH ST, ENID, OK 73701-6864
(580) 237-6847
(580) 237-0948
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3690
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00327766
RR MEDICARE
OK
Enumeration date
06/15/2006
Last updated
04/25/2008
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