Individual
EILEEN M KEOGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
10620 PARK RD, SUITE 200, CHARLOTTE, NC 28210-8472
(704) 667-2500
(704) 667-2507
Mailing address
1100 BLYTHE BLVD, CHARLOTTE, NC 28203-5814
(704) 355-4370
(704) 355-4231
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5068
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1090E
BCBS
NC
01
—
112050
WELLNESS
NC
01
—
295485
MAMSI
NY
05
—
7210558
—
NC
01
—
79106
MEDCOST
NC
Enumeration date
08/01/2006
Last updated
07/08/2007
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