Healthcare Provider Details

I. General information

NPI: 1598144990
Provider Name (Legal Business Name): DAWN LEE KELLER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 05/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FATHER DEVALLES BLVD SUITE 401
FALL RIVER MA
02723-1511
US

IV. Provider business mailing address

4 TRAIP AVE
KITTERY ME
03904-1716
US

V. Phone/Fax

Practice location:
  • Phone: 508-673-5500
  • Fax:
Mailing address:
  • Phone: 207-475-8034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2376
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPA2545
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: