MEDICARE: KIM L KEELER PTA

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	225200000X	Physical Therapy Assistant	0130	NH

General Provider Information

NPI Number	:	1861459299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM L KEELER PTA

Provider Business Mailing Address
First Line	:	501 SOUTH ST
Second Line	:	BOW PHYSICAL THERAPY AND SPINE CENTER
City	:	BOW
State	:	NH
Zip	:	03304
Country	:	US
Telephone Number	:	603-224-5883
Fax Number	:	603-224-6042

Provider Business Practice Location Address
First Line	:	501 SOUTH ST
Second Line	:	BOW PHYSICAL THERAPY AND SPINE CENTER
City	:	BOW
State	:	NH
Zip	:	03304
Country	:	US
Telephone Number	:	603-224-5883
Fax Number	:	603-224-6042

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	07/08/2007

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Directions to “ KIM L KEELER PTA” Practice Location

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