Provider Demographics
NPI:1194807073
Name:DRURY, KEITH R (PT)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:R
Last Name:DRURY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 SOUTHWAY AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-3783
Mailing Address - Country:US
Mailing Address - Phone:208-746-1418
Mailing Address - Fax:208-746-4123
Practice Address - Street 1:678 SOUTHWAY AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-3783
Practice Address - Country:US
Practice Address - Phone:208-746-1418
Practice Address - Fax:208-746-4123
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0112038OtherWALI
ID7023864OtherWAPA
ID1000927OtherCHAMPUS/BLUECROSS
ID390090OtherREGENCE GRP
ID1000927OtherCHAMPUS/BLUECROSS