Healthcare Provider Details

I. General information

NPI: 1831152172
Provider Name (Legal Business Name): PHILIP THOMAS KEATING P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 10/25/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551A W MAIN ST
ROCKAWAY NJ
07866-3733
US

IV. Provider business mailing address

29 APACHE TRL
ROCKAWAY NJ
07866-1028
US

V. Phone/Fax

Practice location:
  • Phone: 973-586-2556
  • Fax:
Mailing address:
  • Phone: 973-586-2556
  • Fax: 973-586-9798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number017422
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: