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General NPI Number Information
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NPI Number | 1922518042
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Entity Type | Organization
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Legal Business Name | KELLER HEALING & PHYSICAL MEDICINE, P.A.
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Dates
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Enumeration Date | 10/03/2017
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Last Update Date | 10/03/2017
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Provider Practice Location Address
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Address Line | 804 KELLER PKWY
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City | KELLER
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State | TX
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Zip | 76248
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Country | US
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Telephone | 316-882-5353
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Fax |
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Provider Business Mailing Address
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Address Line | 804 KELLER PKWY
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City | KELLER
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State | TX
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Zip | 76248-2405
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DR. TIMOTHY DALE WARREN
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Credential | DC
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Telephone | 316-882-5353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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