Provider Demographics
NPI:1316911480
Name:KEEN, DOUGLAS EDWARD (LAT,ATC,RTR)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:EDWARD
Last Name:KEEN
Suffix:
Gender:M
Credentials:LAT,ATC,RTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16720 YEOMAN WAY
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8092
Mailing Address - Country:US
Mailing Address - Phone:317-867-0868
Mailing Address - Fax:
Practice Address - Street 1:755 W CARMEL DR
Practice Address - Street 2:SUITE 150
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5877
Practice Address - Country:US
Practice Address - Phone:317-876-7503
Practice Address - Fax:317-595-1190
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer