Individual
LISA KEANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2100 38TH ST NW, CANTON, OH 44709-2312
(330) 492-8136
Mailing address
722 GREENBRIER SQ NE, BOLIVAR, OH 44612-8819
(330) 492-8136
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-1651
OH
Other
Enumeration date
08/15/2014
Last updated
08/15/2014
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