Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1687 | ND |
N | 2251P0200X | Physical Therapist - Pediatrics | 1687 | ND |
NPI | 1043568611 |
---|---|
Provider Name | Sarah C Keller |
First Address | Bismarck, ND 58501-4520 |
Second Address | Bismarck, ND 58501-4520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2012 |
Last Update Date | 29/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1687 | LICENSE (01) | ND |