Provider Demographics
NPI:1366102857
Name:MCKEIGHAN, CAROLINE HANNA (DPT)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:HANNA
Last Name:MCKEIGHAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19946 ALDERWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2060
Mailing Address - Country:US
Mailing Address - Phone:518-956-1462
Mailing Address - Fax:
Practice Address - Street 1:20225 POWERS RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2128
Practice Address - Country:US
Practice Address - Phone:541-318-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-23
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.01343572251X0800X
OR65138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic