Healthcare Provider Details

I. General information

NPI: 1841450178
Provider Name (Legal Business Name): PAUL ANDREW KELLER P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 CHAMBERS ST
EUGENE OR
97405-1861
US

IV. Provider business mailing address

2095 HARVARD DR
EUGENE OR
97405-1079
US

V. Phone/Fax

Practice location:
  • Phone: 541-687-1310
  • Fax:
Mailing address:
  • Phone: 541-393-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3920
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: