=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720967300
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEEGAN JACOB GARMA NESS DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2025
-----------------------------------------------------
Last Update Date | 08/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10015 FOOTHILLS BLVD # 130
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95747-7101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-905-6378
-----------------------------------------------------
Fax | 916-672-0114
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1088 PROVENCE VILLAGE DR
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95747-6603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-969-6334
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 308574
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------