Individual
CHRISTIANNA KEOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
627 COLLEGE HWY STE 6, SOUTHWICK, MA 01077-9829
(137) 862-2504
(413) 736-2254
Mailing address
1111 ELM ST STE 9, WEST SPRINGFIELD, MA 01089-1540
(413) 736-2250
(413) 736-2254
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
007836
CT
225100000X
Physical Therapist
Primary
16179
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001419701
—
MA
01
—
110112581A
MASSHEALTH
MA
Enumeration date
07/11/2006
Last updated
08/02/2021
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