Provider Demographics
NPI:1063725216
Name:KEETON, LAUREN BROOKE
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:BROOKE
Last Name:KEETON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LAUREN
Other - Middle Name:BROOKE
Other - Last Name:KEETON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:118 HERRON ST
Mailing Address - Street 2:
Mailing Address - City:FT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-3126
Mailing Address - Country:US
Mailing Address - Phone:706-861-7471
Mailing Address - Fax:706-861-7472
Practice Address - Street 1:118 HERRON ST
Practice Address - Street 2:
Practice Address - City:FT. OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742
Practice Address - Country:US
Practice Address - Phone:706-861-7471
Practice Address - Fax:706-861-7472
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0099752251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics