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General NPI Number Information
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NPI Number | 1457175721
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Entity Type | Individual
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Provider Name | KYLE JOHN KELLER
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Gender | Male
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 2865 N REYNOLDS RD
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City | TOLEDO
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State | OH
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Zip | 43615-2068
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Country | US
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Telephone | 419-654-4934
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Fax | 419-539-0239
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Provider Business Mailing Address
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Address Line | 2865 N REYNOLDS RD
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City | TOLEDO
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State | OH
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Zip | 43615-2068
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Country | US
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Telephone | 419-654-4934
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Fax | 419-539-0239
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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 | 224Y00000X
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Taxonomy Name | Clinical Exercise Physiologist
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License Number |
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License Number State |
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