Provider Demographics
NPI:1700824414
Name:KEEGAN, AMANDA (PT)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:KEEGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE GARNETT LANE
Mailing Address - Street 2:NORTHERN RI PHYSICAL THERAPY
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828-1414
Mailing Address - Country:US
Mailing Address - Phone:401-949-0380
Mailing Address - Fax:401-949-5581
Practice Address - Street 1:ONE GARNETT LANE
Practice Address - Street 2:NORTHERN RI PHYSICAL THERAPY
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828-1414
Practice Address - Country:US
Practice Address - Phone:401-949-0380
Practice Address - Fax:401-949-5581
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT00582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI26679OtherNEIGHBORHOOD PIN
RI75277OtherRI BLUE CROSS
RI8225OtherNEIGHBORHOOD PIN GROUP
RI402508OtherBLUE CHIP
6400148OtherUNITED HEALTH OF NEW ENGL
050456866OtherTAX ID
007001715Medicare UPIN