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General NPI Number Information
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NPI Number | 1740969856
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Entity Type | Individual
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Provider Name | KEEGAN KIMMINAU DPT
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Gender | Male
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 06/24/2024
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Provider Practice Location Address
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Address Line | 5345 MARIAN LN
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-1841
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Country | US
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Telephone | 757-456-5018
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Fax |
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Provider Business Mailing Address
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Address Line | 222 TIMBER VALLEY DR
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City | LINN VALLEY
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State | KS
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Zip | 66040-5396
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Country | US
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Telephone | 913-244-1690
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | CP031999T
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11-07283
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License Number State | KS
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