Provider Demographics
NPI:1003107269
Name:KEOHANE, RICHARD STEPHEN SR (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:STEPHEN
Last Name:KEOHANE
Suffix:SR
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-2156
Mailing Address - Country:US
Mailing Address - Phone:718-755-5047
Mailing Address - Fax:
Practice Address - Street 1:26 WALLACE AVE
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-2156
Practice Address - Country:US
Practice Address - Phone:718-755-5047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7886225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist