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General NPI Number Information
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NPI Number | 1356761886
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Entity Type | Individual
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Provider Name | KEVIN ALAN KEENE MS, LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 04/23/2014
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Last Update Date | 04/23/2014
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Provider Practice Location Address
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Address Line | 855 SOUTH NEW STREET
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City | WEST CHESTER
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State | PA
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Zip | 19382
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Country | US
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Telephone | 215-264-8952
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Fax |
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Provider Business Mailing Address
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Address Line | 751 PADDOCK PL
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City | NORTH WALES
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State | PA
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Zip | 19454-2706
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Country | US
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Telephone | 215-264-8952
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RT005406
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License Number State | PA
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