Healthcare Provider Details

I. General information

NPI: 1518805837
Provider Name (Legal Business Name): JESSICA KELLER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 W HIGH ST STE 150
LIMA OH
45801-3980
US

IV. Provider business mailing address

5485 W BREESE RD
LIMA OH
45806-9432
US

V. Phone/Fax

Practice location:
  • Phone: 419-226-9019
  • Fax: 419-226-9244
Mailing address:
  • Phone: 419-226-9019
  • Fax: 419-226-9244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT015394
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: