Provider Demographics
NPI:1356319818
Name:KEENAN, KERRI (PT)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:KEENAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:LYNN
Other - Last Name:BOWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:157 E 86TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2175
Mailing Address - Country:US
Mailing Address - Phone:212-831-3315
Mailing Address - Fax:212-831-9079
Practice Address - Street 1:157 E 86TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2175
Practice Address - Country:US
Practice Address - Phone:212-831-3315
Practice Address - Fax:212-831-9079
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY020259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist