Provider Demographics
NPI:1356676043
Name:KEENAN, JOANNA M (PT)
Entity Type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:M
Last Name:KEENAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 PUTNAM ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-3005
Mailing Address - Country:US
Mailing Address - Phone:740-373-9446
Mailing Address - Fax:740-373-7074
Practice Address - Street 1:1120 POLARIS PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-4042
Practice Address - Country:US
Practice Address - Phone:614-433-0264
Practice Address - Fax:614-545-0474
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH012300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2073241Medicaid
OH2073241Medicaid