Healthcare Provider Details

I. General information

NPI: 1629370762
Provider Name (Legal Business Name): KELLER MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2010
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 LAKE BOONE TRL SUITE 2E
RALEIGH NC
27607-7503
US

IV. Provider business mailing address

4601 LAKE BOONE TRL SUITE 2E
RALEIGH NC
27607-7503
US

V. Phone/Fax

Practice location:
  • Phone: 919-781-3978
  • Fax: 919-781-4315
Mailing address:
  • Phone: 919-781-3978
  • Fax: 919-781-4315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNC

VIII. Authorized Official

Name: COURTNEY NOVEY KELLER
Title or Position: PRESIDENT
Credential: MS, PT, PPI
Phone: 919-781-3978