Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT019200 | PA |
N | 2251G0304X | Physical Therapist - Geriatrics | PT019200 | PA |
NPI | 1144639485 |
---|---|
Provider Name | Mollie Keller |
First Address | Lima, OH 45805 |
Second Address | Greensburg, PA 15601-6414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2014 |
Last Update Date | 03/12/2015 |