Provider Demographics
NPI:1730173428
Name:KEENE, BENJAMIN E (PT, DPT,OCS, FAAOMPT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:E
Last Name:KEENE
Suffix:
Gender:M
Credentials:PT, DPT,OCS, FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 FAR WEST BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3080
Mailing Address - Country:US
Mailing Address - Phone:512-832-9411
Mailing Address - Fax:512-832-9401
Practice Address - Street 1:3508 FAR WEST BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3080
Practice Address - Country:US
Practice Address - Phone:512-832-9411
Practice Address - Fax:512-832-9401
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11418442251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166525901Medicaid
TX8T2545OtherBCBS INDIV PROVIDER ID
TX8T2545OtherBCBS INDIV PROVIDER ID
TXQ19291Medicare UPIN
TXP00275721Medicare PIN