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NPI Code Detail

MEDICARE: JOHN WESLEY KELLER LAT, ATC

MEDICARE: JOHN WESLEY KELLER LAT, ATC
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
12255A2300XAthletic Trainer36000632AIN

General Provider Information

NPI Number : 1750373916
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN WESLEY KELLER LAT, ATC
Provider Business Mailing Address
First Line : 8450 NORTHWEST BLVD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46278-1381
Country : US
Telephone Number : 317-802-2094
Fax Number :
Provider Business Practice Location Address
First Line : 8450 NORTHWEST BLVD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46278-1381
Country : US
Telephone Number : 317-802-2094
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2005
Last Update Date : 07/08/2007

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Directions to “ JOHN WESLEY KELLER LAT, ATC” Practice Location

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