Provider Demographics
NPI:1598301012
Name:KEAGY, NICHOLE LYNN-MURI (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:LYNN-MURI
Last Name:KEAGY
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16422 DUNNINGS HWY
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-5331
Mailing Address - Country:US
Mailing Address - Phone:814-695-4284
Mailing Address - Fax:
Practice Address - Street 1:16422 DUNNINGS HWY
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-5331
Practice Address - Country:US
Practice Address - Phone:814-695-4284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0041132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer