Provider Demographics
NPI:1366732463
Name:MARENGO PHYSICAL THERAPY & DISC INSTITUTE, INC.
Entity type:Organization
Organization Name:MARENGO PHYSICAL THERAPY & DISC INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:E
Authorized Official - Last Name:KEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-289-4445
Mailing Address - Street 1:1355 US HIGHWAY 80 W
Mailing Address - Street 2:
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732
Mailing Address - Country:US
Mailing Address - Phone:334-289-4445
Mailing Address - Fax:334-289-2778
Practice Address - Street 1:1355 US HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732
Practice Address - Country:US
Practice Address - Phone:334-289-4445
Practice Address - Fax:334-289-2778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty