Provider Demographics
NPI:1750749024
Name:FLYNN, KEEGAN (ATC)
Entity type:Individual
Prefix:
First Name:KEEGAN
Middle Name:
Last Name:FLYNN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4823
Mailing Address - Country:US
Mailing Address - Phone:716-912-4257
Mailing Address - Fax:
Practice Address - Street 1:169 LAKE ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4823
Practice Address - Country:US
Practice Address - Phone:716-912-4257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer