Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2305208858 | VA |
NPI | 1003225186 |
---|---|
Provider Name | Rebecca A Keller |
First Address | Charlottesville, VA 22901-7405 |
Second Address | Charlottesville, VA 22901-7405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2014 |
Last Update Date | 04/08/2014 |