Provider Demographics
NPI:1154060911
Name:KEEGAN, JEFFREY CHRISTOPHER (DPT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:CHRISTOPHER
Last Name:KEEGAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-4471
Mailing Address - Country:US
Mailing Address - Phone:910-754-8858
Mailing Address - Fax:
Practice Address - Street 1:237 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-4471
Practice Address - Country:US
Practice Address - Phone:910-754-8858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT029524225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist