Provider Demographics
NPI:1124767025
Name:MCKEITHEN, WILLIAM FRANKLIN JR (PTA)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:FRANKLIN
Last Name:MCKEITHEN
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13728 SUNRISE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32409-2597
Mailing Address - Country:US
Mailing Address - Phone:850-348-1355
Mailing Address - Fax:
Practice Address - Street 1:13728 SUNRISE LN
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:FL
Practice Address - Zip Code:32409-2597
Practice Address - Country:US
Practice Address - Phone:850-348-1355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19354225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant