Provider Demographics
NPI:1396842266
Name:KEENAN, REBECCA LYNN (RPT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYNN
Last Name:KEENAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LINDEN PL
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1609
Mailing Address - Country:US
Mailing Address - Phone:845-741-6564
Mailing Address - Fax:
Practice Address - Street 1:1A MAIN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1932
Practice Address - Country:US
Practice Address - Phone:973-726-0111
Practice Address - Fax:973-726-0399
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020338-01225100000X
NJ40QA00586000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ104859VUJMedicare ID - Type Unspecified