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NPI Code Detail

MEDICARE: ELIZABETH RENEE KELLER DPT

MEDICARE: ELIZABETH RENEE KELLER DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist10765MN

General Provider Information

NPI Number : 1588187462
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH RENEE KELLER DPT
Provider Business Mailing Address
First Line : 7825 3RD ST N
Second Line : STE 105
City : OAKDALE
State : MN
Zip : 55128-5444
Country : US
Telephone Number : 952-835-4512
Fax Number : 888-425-0398
Provider Business Practice Location Address
First Line : 5400 FRANCE AVE S
Second Line :
City : EDINA
State : MN
Zip : 55410-2356
Country : US
Telephone Number : 952-835-4512
Fax Number : 888-425-0398
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2017
Last Update Date : 06/14/2021

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Directions to “ ELIZABETH RENEE KELLER DPT” Practice Location

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