Provider Demographics
NPI:1487636510
Name:KEESEE, JASON ALLEN (ATC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ALLEN
Last Name:KEESEE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 HAWTHORN DR
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-8008
Mailing Address - Country:US
Mailing Address - Phone:843-235-2930
Mailing Address - Fax:
Practice Address - Street 1:4900 SOCASTEE BLVD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7221
Practice Address - Country:US
Practice Address - Phone:843-293-2513
Practice Address - Fax:843-293-9059
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2212255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer