Provider Demographics
NPI:1982021556
Name:KEEN, RHONDA VINCENT (PT)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:VINCENT
Last Name:KEEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:KAYE
Other - Last Name:VINCENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4835 SPRINGFIELD DR
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4913
Mailing Address - Country:US
Mailing Address - Phone:678-234-5292
Mailing Address - Fax:
Practice Address - Street 1:4835 SPRINGFIELD DR
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4913
Practice Address - Country:US
Practice Address - Phone:678-234-5292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004932225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000966765AMedicaid