Provider Demographics
NPI:1346254695
Name:KEENAN, KRISTIN S (PT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:S
Last Name:KEENAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:NEWFIELDS
Mailing Address - State:NH
Mailing Address - Zip Code:03856-8235
Mailing Address - Country:US
Mailing Address - Phone:603-580-5642
Mailing Address - Fax:603-580-5642
Practice Address - Street 1:34 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:NEWFIELDS
Practice Address - State:NH
Practice Address - Zip Code:03856-8235
Practice Address - Country:US
Practice Address - Phone:603-580-5642
Practice Address - Fax:603-580-5642
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15262225100000X
NH3207225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAKE Y68708Medicare ID - Type UnspecifiedPHYSICAL THERAPY