Provider Demographics
NPI:1871158386
Name:KEUNE, JAMIE LAUREN (MT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LAUREN
Last Name:KEUNE
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30081 N 70TH DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-3048
Mailing Address - Country:US
Mailing Address - Phone:602-488-8980
Mailing Address - Fax:
Practice Address - Street 1:30081 N 70TH DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-3048
Practice Address - Country:US
Practice Address - Phone:602-488-8980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17528225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist