MEDICARE: BENJAMIN E KEENE PT, DPT,OCS, FAAOMPT

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	2251X0800X	Orthopedic Physical Therapist	1141844	TX

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
2	8T2545	OTHER	TX	BCBS INDIV PROVIDER ID

General Provider Information

NPI Number	:	1730173428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN E KEENE PT, DPT,OCS, FAAOMPT

Provider Business Mailing Address
First Line	:	3508 FAR WEST BLVD
Second Line	:	SUITE 240
City	:	AUSTIN
State	:	TX
Zip	:	78731-3080
Country	:	US
Telephone Number	:	512-832-9411
Fax Number	:	512-832-9401

Provider Business Practice Location Address
First Line	:	3508 FAR WEST BLVD
Second Line	:	SUITE 240
City	:	AUSTIN
State	:	TX
Zip	:	78731-3080
Country	:	US
Telephone Number	:	512-832-9411
Fax Number	:	512-832-9401

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	08/20/2014

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Directions to “ BENJAMIN E KEENE PT, DPT,OCS, FAAOMPT” Practice Location

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