1295771566 NPI number — KAREN L KEEGAN PT, MDT

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295771566 NPI number — KAREN L KEEGAN PT, MDT

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KEEGAN

Provider First Name:

KAREN

Provider Middle Name:

L

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

PT, MDT

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

SEEGER

Provider Other First Name:

KAREN

Provider Other Middle Name:

L

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

1

NPI Number:

1295771566

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/27/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

7 DOCK HILL RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MIDDLEBURG

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

17842-8910

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

570-837-2123

Provider Business Mailing Address Fax Number:

570-837-2185

Provider First Line Business Practice Location Address:

836 HOUSTON RUN DR STE 101

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

GAP

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

17527-9496

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

717-442-8957

Provider Business Practice Location Address Fax Number:

717-442-1063

Provider Enumeration Date:

06/22/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 225100000X , with the licence number:  J10000932 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 225100000X , with the licence number: PT007844L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 292883 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
• Identifier: 2279316000 . This is a "AMERIHEALTH IBC" identifier . This identifiers is of the category "OTHER".
• Identifier: 5070-0035 . This is a "CAREFIRST/FEDERAL" identifier . This identifiers is of the category "OTHER".
• Identifier: 1000037856 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
• Identifier: J10000932 . This is a "DE LICENSE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
• Identifier: 1600643 . This is a "PA BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 5070-0035 . This is a "CARE FIRST" identifier . This identifiers is of the category "OTHER".
• Identifier: 620720-01 . This is a "CAREFIRST/NCA" identifier . This identifiers is of the category "OTHER".
• Identifier: 62072001 . This is a "NCA" identifier . This identifiers is of the category "OTHER".
• Identifier: P00398574 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".