Provider Demographics
NPI:1639336928
Name:KEENEY-ROE, ALYSSA (PT, MS)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:KEENEY-ROE
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DANIEL BURNHAM CT
Mailing Address - Street 2:SUITE 325C
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5455
Mailing Address - Country:US
Mailing Address - Phone:415-776-1646
Mailing Address - Fax:
Practice Address - Street 1:165 N REDWOOD DR
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1969
Practice Address - Country:US
Practice Address - Phone:415-499-0278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34123225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist