Provider Demographics
NPI:1851959597
Name:KEETING, JACOB E
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:E
Last Name:KEETING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 LINCOLN AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022-2451
Mailing Address - Country:US
Mailing Address - Phone:724-483-2159
Mailing Address - Fax:
Practice Address - Street 1:3109 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-0382
Practice Address - Country:US
Practice Address - Phone:304-241-5670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV004130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist