Healthcare Provider Details

I. General information

NPI: 1700824414
Provider Name (Legal Business Name): AMANDA KEEGAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE GARNETT LANE NORTHERN RI PHYSICAL THERAPY
GREENVILLE RI
02828-1414
US

IV. Provider business mailing address

ONE GARNETT LANE NORTHERN RI PHYSICAL THERAPY
GREENVILLE RI
02828-1414
US

V. Phone/Fax

Practice location:
  • Phone: 401-949-0380
  • Fax: 401-949-5581
Mailing address:
  • Phone: 401-949-0380
  • Fax: 401-949-5581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00582
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: