=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518891001
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEEGAN FEROAH DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2026
-----------------------------------------------------
Last Update Date | 06/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2484 WINGFIELD HILLS RD
-----------------------------------------------------
City | SPARKS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89436-7205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-993-3640
-----------------------------------------------------
Fax | 775-993-3641
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1175 SENTINEL CIR
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89509-3517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-507-4210
-----------------------------------------------------
Fax | 775-507-4209
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 7021
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------