1700824414 NPI number — MS. AMANDA KEEGAN PT

Table of content: MS. AMANDA KEEGAN PT (NPI 1700824414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700824414 NPI number — MS. AMANDA KEEGAN PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEEGAN
Provider First Name:
AMANDA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700824414
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE GARNETT LANE
Provider Second Line Business Mailing Address:
NORTHERN RI PHYSICAL THERAPY
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02828-1414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-949-0380
Provider Business Mailing Address Fax Number:
401-949-5581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE GARNETT LANE
Provider Second Line Business Practice Location Address:
NORTHERN RI PHYSICAL THERAPY
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02828-1414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-949-0380
Provider Business Practice Location Address Fax Number:
401-949-5581
Provider Enumeration Date:
06/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT00582 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 26679 . This is a "NEIGHBORHOOD PIN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 75277 . This is a "RI BLUE CROSS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 8225 . This is a "NEIGHBORHOOD PIN GROUP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 402508 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 6400148 . This is a "UNITED HEALTH OF NEW ENGL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050456866 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".




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