Provider Demographics
NPI:1154374924
Name:KEEN, JORDAN VALERIE (MSPT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:VALERIE
Last Name:KEEN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:VALERIE
Other - Middle Name:JORDAN
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:130 HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4571
Mailing Address - Country:US
Mailing Address - Phone:352-419-6570
Mailing Address - Fax:888-639-2521
Practice Address - Street 1:130 HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4571
Practice Address - Country:US
Practice Address - Phone:352-419-6570
Practice Address - Fax:888-639-2521
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27862225100000X
VA23052041902251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010206456Medicaid
VAP00466835OtherRR MEDICARE
FLPT27862OtherTHERAPY LICIENCE
FLPT27862OtherTHERAPY LICIENCE
VA010206456Medicaid