MEDICARE: ZACHARY KELLER P.T.

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
1	225100000X	Physical Therapist	1174028	TX

General Provider Information

NPI Number	:	1750548251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY KELLER P.T.

Provider Business Mailing Address
First Line	:	2600 COLE AVE APT 216
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-0949
Country	:	US
Telephone Number	:	405-249-0794
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 COLE AVE APT 216
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-0949
Country	:	US
Telephone Number	:	405-249-0794
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	09/18/2024

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