Provider Demographics
NPI:1043590136
Name:KEENAN, BRYANA BERNADETTE (DPT)
Entity type:Individual
Prefix:MISS
First Name:BRYANA
Middle Name:BERNADETTE
Last Name:KEENAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6207 SHERIDAN AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1060
Mailing Address - Country:US
Mailing Address - Phone:512-454-3743
Mailing Address - Fax:512-334-4465
Practice Address - Street 1:6207 SHERIDAN AVE STE 601
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1060
Practice Address - Country:US
Practice Address - Phone:512-454-3743
Practice Address - Fax:512-334-4465
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1266473225100000X
MD23742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist