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General NPI Number Information
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NPI Number | 1033754353
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Entity Type | Individual
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Provider Name | JENIECE MARIE KEGLEY
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Gender | Female
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Dates
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Enumeration Date | 11/11/2019
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Last Update Date | 02/14/2020
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Provider Practice Location Address
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Address Line | 1539 COUNTRY CLUB RD
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City | FAIRMONT
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State | WV
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Zip | 26554-1306
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Country | US
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Telephone | 843-235-9393
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Fax |
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Provider Business Mailing Address
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Address Line | 655 S WILLOW ST STE 128
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City | MANCHESTER
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State | NH
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Zip | 03103-5717
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT31710
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 9038
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1286726
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 004043
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License Number State | WV
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