Provider Demographics
NPI:1205261336
Name:KEIM, DARIN (PTA)
Entity type:Individual
Prefix:
First Name:DARIN
Middle Name:
Last Name:KEIM
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 1/2 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-1619
Mailing Address - Country:US
Mailing Address - Phone:502-604-1775
Mailing Address - Fax:
Practice Address - Street 1:21 1/2 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-1619
Practice Address - Country:US
Practice Address - Phone:502-604-1775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09028225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant