Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40QA01617600 | NJ |
NPI | 1992174494 |
---|---|
Provider Name | Stephanie Theresa Keller |
First Address | East Hanover, NJ 07936-3167 |
Second Address | Sparta, NJ 07871-1989 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2015 |
Last Update Date | 01/03/2019 |