Provider Demographics
NPI:1144328345
Name:KELLER, DEBORAH SUZANNE (PT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:SUZANNE
Last Name:KELLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 HIGHWAY 327 E
Mailing Address - Street 2:
Mailing Address - City:SILSBEE
Mailing Address - State:TX
Mailing Address - Zip Code:77656-5120
Mailing Address - Country:US
Mailing Address - Phone:409-385-2500
Mailing Address - Fax:409-385-2502
Practice Address - Street 1:1162 HIGHWAY 327 E
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656-5120
Practice Address - Country:US
Practice Address - Phone:409-385-2500
Practice Address - Fax:409-385-2502
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002104225100000X
TX1158718225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1144328345Medicaid
DEP00692870OtherMEDICARE RR
DE1144328345OtherDPCI
DE3748325000OtherIBC
DE1144328345Medicaid