Provider Demographics
NPI:1811362965
Name:KEATING, CHRISTINA (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:KEATING
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 1:57 SPARTA AVE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1822
Mailing Address - Country:US
Mailing Address - Phone:973-726-0111
Mailing Address - Fax:973-726-0399
Practice Address - Street 1:57 SPARTA AVE
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1822
Practice Address - Country:US
Practice Address - Phone:973-726-0111
Practice Address - Fax:973-726-0399
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00752100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ104858Medicare PIN