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General NPI Number Information
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NPI Number | 1598139057
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Entity Type | Individual
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Provider Name | MARISSA LOUISE KEATING
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Gender | Female
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Dates
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Enumeration Date | 11/20/2015
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Last Update Date | 12/08/2017
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Provider Practice Location Address
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Address Line | 1655 EATON ST
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City | LAKEWOOD
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State | CO
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Zip | 80214-1628
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Country | US
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Telephone | 720-232-0695
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Fax |
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Provider Business Mailing Address
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Address Line | 6657 W 61ST AVE
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City | ARVADA
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State | CO
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Zip | 80003-4907
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Country | US
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Telephone | 720-232-0695
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 0011610
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License Number State | CO
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