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General NPI Number Information
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NPI Number | 1043287915
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Entity Type | Individual
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Provider Name | JOHN KELLERSTRASS PT, ATC, MED
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Gender | Male
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Dates
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Enumeration Date | 03/01/2006
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Last Update Date | 07/21/2015
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Provider Practice Location Address
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Address Line | 1553 LYONS RD
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City | CENTERVILLE
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State | OH
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Zip | 45458-1881
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Country | US
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Telephone | 937-438-0647
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Fax |
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Provider Business Mailing Address
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Address Line | 1238 CHAUCER PL
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City | MAINEVILLE
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State | OH
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Zip | 45039-9750
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Country | US
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Telephone | 513-314-1487
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-OH9128
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License Number State | OH
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