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General NPI Number Information
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NPI Number | 1699311092
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Entity Type | Individual
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Provider Name | SANDRA ANN KEENEY LMT
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Gender | Female
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Dates
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Enumeration Date | 11/20/2019
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Last Update Date | 11/20/2019
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Provider Practice Location Address
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Address Line | 3211 S PROVIDENCE RD STE 105
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City | COLUMBIA
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State | MO
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Zip | 65203-3645
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Country | US
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Telephone | 573-825-1601
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Fax |
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Provider Business Mailing Address
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Address Line | 908 W ROLLINS ST
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City | MOBERLY
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State | MO
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Zip | 65270-1353
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 2017025450
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License Number State | MO
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