Provider Demographics
NPI:1093015851
Name:KELLER, COURTNEY NOVEY (MS, PT, PPI)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:NOVEY
Last Name:KELLER
Suffix:
Gender:F
Credentials:MS, PT, PPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5308 RICHLAND DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3580
Mailing Address - Country:US
Mailing Address - Phone:919-614-7312
Mailing Address - Fax:
Practice Address - Street 1:5308 RICHLAND DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3580
Practice Address - Country:US
Practice Address - Phone:919-614-3712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6917225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist