Provider Demographics
NPI:1831309251
Name:KEENEY, JOSEPH H (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:H
Last Name:KEENEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7721 SW 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-1725
Mailing Address - Country:US
Mailing Address - Phone:503-452-7767
Mailing Address - Fax:
Practice Address - Street 1:7721 SW 34TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-1725
Practice Address - Country:US
Practice Address - Phone:503-452-7767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1554225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR107878Medicare ID - Type UnspecifiedMEDICARE