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 1:2661 RIVA RD
Mailing Address - Street 2:BLD 600 STE 601
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7353
Mailing Address - Country:US
Mailing Address - Phone:410-266-6626
Mailing Address - Fax:410-266-3026
Practice Address - Street 1:2661 RIVA RD
Practice Address - Street 2:BLD 600 STE 601
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7353
Practice Address - Country:US
Practice Address - Phone:410-266-6626
Practice Address - Fax:410-266-3026
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist