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General NPI Number Information
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NPI Number | 1629370762
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Entity Type | Organization
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Legal Business Name | KELLER MANAGEMENT, LLC
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Dates
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Enumeration Date | 11/22/2010
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Last Update Date | 11/22/2010
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Provider Practice Location Address
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Address Line | 4601 LAKE BOONE TRL SUITE 2E
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City | RALEIGH
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State | NC
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Zip | 27607-7503
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Country | US
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Telephone | 919-781-3978
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Fax | 919-781-4315
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Provider Business Mailing Address
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Address Line | 4601 LAKE BOONE TRL SUITE 2E
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City | RALEIGH
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State | NC
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Zip | 27607-7503
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Country | US
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Telephone | 919-781-3978
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Fax | 919-781-4315
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Authorized Official
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Title or Position | PRESIDENT
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Name | COURTNEY NOVEY KELLER
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Credential | MS, PT, PPI
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Telephone | 919-781-3978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | NC
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