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NPI Code Detail

MEDICARE: KELLER ANDERSON PT, DPT

MEDICARE: KELLER ANDERSON PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT016778GA

General Provider Information

NPI Number : 1417730599
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLER ANDERSON PT, DPT
Provider Business Mailing Address
First Line : 43032 GARDNER DR
Second Line :
City : ALPHARETTA
State : GA
Zip : 30009-8612
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5660 LAKE FORREST DR
Second Line :
City : ATLANTA
State : GA
Zip : 30342-4635
Country : US
Telephone Number : 404-500-9185
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2023
Last Update Date : 08/14/2023

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