Healthcare Provider Details

I. General information

NPI: 1568186880
Provider Name (Legal Business Name): DANIEL NORMAN KELLER PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W MAIN ST STE 340
BABYLON NY
11702-3009
US

IV. Provider business mailing address

115 CAYUGA AVE
DEER PARK NY
11729-2303
US

V. Phone/Fax

Practice location:
  • Phone: 631-661-3180
  • Fax:
Mailing address:
  • Phone: 631-455-7015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number048941
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: