MEDICARE: DAVID KEENE LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MSG001962	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598142002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID KEENE LMT

Provider Business Mailing Address
First Line	:	619 WYOMING ST
Second Line	:
City	:	WILLIAMSPORT
State	:	PA
Zip	:	17701-3550
Country	:	US
Telephone Number	:	570-419-2779
Fax Number	:

Provider Business Practice Location Address
First Line	:	460 MARKET ST STE 208
Second Line	:
City	:	WILLIAMSPORT
State	:	PA
Zip	:	17701-6322
Country	:	US
Telephone Number	:	570-419-2779
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2015
Last Update Date	:	05/04/2015

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Directions to “ DAVID KEENE LMT” Practice Location

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