Healthcare Provider Details

I. General information

NPI: 1356319818
Provider Name (Legal Business Name): KERRI KEENAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERRI LYNN BOWMAN PT

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 E 86TH ST
NEW YORK NY
10028-2175
US

IV. Provider business mailing address

157 E 86TH ST
NEW YORK NY
10028-2175
US

V. Phone/Fax

Practice location:
  • Phone: 212-831-3315
  • Fax: 212-831-9079
Mailing address:
  • Phone: 212-831-3315
  • Fax: 212-831-9079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberNY020259
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: