Provider Demographics
NPI:1942628599
Name:KEENAN, COLLEEN M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:KEENAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42680
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-0043
Mailing Address - Country:US
Mailing Address - Phone:512-441-6008
Mailing Address - Fax:512-326-2805
Practice Address - Street 1:4310 JAMES CASEY ST
Practice Address - Street 2:SUITE 3C
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1251
Practice Address - Country:US
Practice Address - Phone:512-441-6008
Practice Address - Fax:512-326-2805
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1260853225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB215666Medicare PIN
CAW17215CMedicare PIN