Most Relevant Information
Provider Data
| NPI Number: | 1003526450 |
| Provider Name: | DANIELLE KEOUGH PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: | PTA00821 |
Most Important Dates
| Enumeration Date: | 11/28/2022 |
| Last Updated: | 11/28/2022 |
Provider Practice Location
1139 MAIN AVE
WARWICK
RI
028861940
Practice Location Phone/Fax
| Phone: | 4017396600 |
| Fax: |
Provider Mailing Location
60 STADDEN ST
PROVIDENCE
RI
029073548
Provider Mailing Phone/Fax
| Phone: | 4014472310 |
| Fax: |