Healthcare Provider Details

I. General information

NPI: 1922932680
Provider Name (Legal Business Name): JORDAN KEELEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 PRONGHORN TRL STE 1
BOZEMAN MT
59718-6096
US

IV. Provider business mailing address

1650 LYNDON FARM CT STE 300
LOUISVILLE KY
40223-5005
US

V. Phone/Fax

Practice location:
  • Phone: 406-585-9044
  • Fax: 406-585-9220
Mailing address:
  • Phone: 726-202-3039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPRD-PT-LIC-31692
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: