Provider Demographics
NPI:1942749569
Name:KEENE THERAPY GROUP
Entity Type:Organization
Organization Name:KEENE THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH/LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:KEENE
Authorized Official - Suffix:
Authorized Official - Credentials:M A, CCC-SLP
Authorized Official - Phone:540-609-4130
Mailing Address - Street 1:708 OLD WHITE HILL RD
Mailing Address - Street 2:
Mailing Address - City:STUARTS DRAFT
Mailing Address - State:VA
Mailing Address - Zip Code:24477-3107
Mailing Address - Country:US
Mailing Address - Phone:540-609-4130
Mailing Address - Fax:
Practice Address - Street 1:11 MIDDLEBROOK AVE
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-4233
Practice Address - Country:US
Practice Address - Phone:540-609-4130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA17578222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty