MEDICARE: BO KEELING, PLLC

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
1	261QP2000X	Physical Therapy Clinic/Center	1122315	TX

General Provider Information

NPI Number	:	1639526783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BO KEELING, PLLC

Provider Business Mailing Address
First Line	:	19142 BIG TIMBER RD
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-8610
Country	:	US
Telephone Number	:	903-780-3505
Fax Number	:

Provider Business Practice Location Address
First Line	:	3310 S BROADWAY AVE STE 100I
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-7818
Country	:	US
Telephone Number	:	903-781-1832
Fax Number	:	877-798-4959

Authorized Official
Title or Position	:	OWNER
Name	:	BONITA KEELING
Credential	:	PT
Telephone Number	:	903-780-3505

Provider Enumeration Date	:	05/18/2016
Last Update Date	:	11/12/2024

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