Provider Demographics
NPI:1790938421
Name:KEEGAN, KATHLEEN MARIE (PT, MHS, OCS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIE
Last Name:KEEGAN
Suffix:
Gender:F
Credentials:PT, MHS, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 DEERFIELD CT
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-1546
Mailing Address - Country:US
Mailing Address - Phone:908-229-1033
Mailing Address - Fax:908-766-1236
Practice Address - Street 1:9 DEERFIELD CT
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-1546
Practice Address - Country:US
Practice Address - Phone:908-229-1033
Practice Address - Fax:908-766-1236
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-26
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA005275002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic