Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 7886 | NY |
NPI | 1003107269 |
---|---|
Provider Name | Mr. Richard Stephen Keohane SR. |
First Address | North Baldwin, NY 11510-2156 |
Second Address | North Baldwin, NY 11510-2156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2011 |
Last Update Date | 22/04/2011 |