Provider Demographics
NPI:1114370400
Name:KEOGH, ELIZABETH LEUCI (PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEUCI
Last Name:KEOGH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:KEOGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:8812 151ST AVE
Mailing Address - Street 2:APT 5L
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-1450
Mailing Address - Country:US
Mailing Address - Phone:917-482-4942
Mailing Address - Fax:
Practice Address - Street 1:8812 151ST AVE
Practice Address - Street 2:APT 5L
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-1450
Practice Address - Country:US
Practice Address - Phone:917-482-4942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist