Provider Demographics
NPI:1407211469
Name:KEANE, SHAWN (ATC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:KEANE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3446 PIN OAK LN
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-3459
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 E LANCASTER AVE
Practice Address - Street 2:JAKE NEVIN FIELDHOUSE
Practice Address - City:VILLANOVA
Practice Address - State:PA
Practice Address - Zip Code:19085-1603
Practice Address - Country:US
Practice Address - Phone:610-519-7430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0047682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer