Provider Demographics
NPI:1144395955
Name:KEANE, JENNIE MARIE (PT)
Entity Type:Individual
Prefix:MS
First Name:JENNIE
Middle Name:MARIE
Last Name:KEANE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JEANNIE
Other - Middle Name:MARIE
Other - Last Name:VANDER LINDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 DOROTHY AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2209
Mailing Address - Country:US
Mailing Address - Phone:508-852-5228
Mailing Address - Fax:
Practice Address - Street 1:195 COLLYER ST.
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906
Practice Address - Country:US
Practice Address - Phone:401-793-4080
Practice Address - Fax:401-793-4110
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI01809225100000X
MA17052225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist