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General NPI Number Information
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NPI Number | 1639526783
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Entity Type | Organization
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Legal Business Name | BO KEELING, PLLC
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 3310 S BROADWAY AVE STE 100I
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City | TYLER
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State | TX
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Zip | 75701-7818
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Country | US
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Telephone | 903-781-1832
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Fax | 877-798-4959
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Provider Business Mailing Address
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Address Line | 19142 BIG TIMBER RD
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City | TYLER
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State | TX
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Zip | 75703-8610
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Country | US
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Telephone | 903-780-3505
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BONITA KEELING
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Credential | PT
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Telephone | 903-780-3505
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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 | 1122315
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License Number State | TX
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