Provider Demographics
NPI:1679719645
Name:KEENAN, MICHAEL PAUL (PT,DPT,ATC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PAUL
Last Name:KEENAN
Suffix:
Gender:M
Credentials:PT,DPT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 412969
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2066
Mailing Address - Country:US
Mailing Address - Phone:914-294-4050
Mailing Address - Fax:
Practice Address - Street 1:110 ARDMORE AVE UNIT A
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-1339
Practice Address - Country:US
Practice Address - Phone:484-498-8299
Practice Address - Fax:484-494-2938
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0708020682255A2300X
PAPT024089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer