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General NPI Number Information
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NPI Number | 1760084313
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Entity Type | Individual
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Provider Name | STONE WILLIAM KELLER
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Gender | Male
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Dates
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Enumeration Date | 11/09/2020
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Last Update Date | 11/09/2020
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Provider Practice Location Address
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Address Line | 2200 W EAU GALLIE BLVD STE 105
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City | MELBOURNE
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State | FL
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Zip | 32935-3166
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Country | US
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Telephone | 321-255-2818
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Fax |
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Provider Business Mailing Address
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Address Line | 782 READING ST SE
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City | PALM BAY
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State | FL
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Zip | 32909-7228
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Country | US
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Telephone | 321-750-6301
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA30576
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License Number State | FL
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