Provider Demographics
NPI:1871592782
Name:KEANE, KATHLEEN (PT)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:KEANE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 AUDREY AVE
Mailing Address - Street 2:
Mailing Address - City:OYSTER BAY
Mailing Address - State:NY
Mailing Address - Zip Code:11771-1522
Mailing Address - Country:US
Mailing Address - Phone:516-922-2977
Mailing Address - Fax:516-922-2975
Practice Address - Street 1:27 AUDREY AVE
Practice Address - Street 2:
Practice Address - City:OYSTER BAY
Practice Address - State:NY
Practice Address - Zip Code:11771-1522
Practice Address - Country:US
Practice Address - Phone:516-922-2977
Practice Address - Fax:516-922-2975
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020990-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ14R71Medicare ID - Type Unspecified