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NPI Code Detail

MEDICARE: JOSEPH M KELLER

MEDICARE: JOSEPH M KELLER
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
1225200000XPhysical Therapy AssistantPTA003393GA

General Provider Information

NPI Number : 1598329112
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH M KELLER
Provider Business Mailing Address
First Line : 134 OLD CANTON RD
Second Line :
City : BALL GROUND
State : GA
Zip : 30107-4002
Country : US
Telephone Number : 678-662-2284
Fax Number :
Provider Business Practice Location Address
First Line : 105 ARNOLD MILL RD
Second Line :
City : WOODSTOCK
State : GA
Zip : 30188-5027
Country : US
Telephone Number : 770-926-0016
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2019
Last Update Date : 04/29/2019

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