Healthcare Provider Details

I. General information

NPI: 1184503948
Provider Name (Legal Business Name): KEEGAN PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2146 NE 123RD ST
NORTH MIAMI FL
33181-2902
US

IV. Provider business mailing address

2142 NE 123RD ST
NORTH MIAMI FL
33181-2902
US

V. Phone/Fax

Practice location:
  • Phone: 305-967-8976
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT43250
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: