Provider Demographics
NPI:1346746997
Name:KEEN ORTHO & REHAB PHYSIOTHERAPY
Entity Type:Organization
Organization Name:KEEN ORTHO & REHAB PHYSIOTHERAPY
Other - Org Name:KEEN ORTHO & REHAB PHYSIOTHERAPY PLLC.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HOSTETLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:865-622-5043
Mailing Address - Street 1:5101 MARGUERITE RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-5411
Mailing Address - Country:US
Mailing Address - Phone:865-622-5043
Mailing Address - Fax:865-622-5066
Practice Address - Street 1:813 KERMIT DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912
Practice Address - Country:US
Practice Address - Phone:865-622-5043
Practice Address - Fax:865-622-5066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty