Provider Demographics
NPI:1427603463
Name:KEOUGH, AIMEE T (LAT, ATC, CSCS)
Entity Type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:T
Last Name:KEOUGH
Suffix:
Gender:F
Credentials:LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-4135
Mailing Address - Country:US
Mailing Address - Phone:215-261-6878
Mailing Address - Fax:
Practice Address - Street 1:8000 CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-4135
Practice Address - Country:US
Practice Address - Phone:215-261-6878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0036422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer