Healthcare Provider Details

I. General information

NPI: 1700797982
Provider Name (Legal Business Name): KEEGAN REARDON PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 SWEET HOME RD STE 130
AMHERST NY
14228-2243
US

IV. Provider business mailing address

2420 SWEET HOME RD STE 130
AMHERST NY
14228-2243
US

V. Phone/Fax

Practice location:
  • Phone: 716-525-1184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number056477
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: