Provider Demographics
NPI:1902989692
Name:KELLER, GERALD C (PT)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:C
Last Name:KELLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 SE 3RD CT
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-7127
Mailing Address - Country:US
Mailing Address - Phone:954-263-8031
Mailing Address - Fax:954-975-9754
Practice Address - Street 1:240 SE 3RD CT
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-7127
Practice Address - Country:US
Practice Address - Phone:954-263-8031
Practice Address - Fax:954-975-9754
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2672225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0002672OtherSTATE LICENSE