Provider Demographics
NPI:1114199023
Name:JO ANNE KELLER PT LLC
Entity Type:Organization
Organization Name:JO ANNE KELLER PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:814-885-6507
Mailing Address - Street 1:779 BRANDY CAMP RD
Mailing Address - Street 2:
Mailing Address - City:KERSEY
Mailing Address - State:PA
Mailing Address - Zip Code:15846-1503
Mailing Address - Country:US
Mailing Address - Phone:814-885-6507
Mailing Address - Fax:814-885-6282
Practice Address - Street 1:779 BRANDY CAMP RD
Practice Address - Street 2:
Practice Address - City:KERSEY
Practice Address - State:PA
Practice Address - Zip Code:15846-1503
Practice Address - Country:US
Practice Address - Phone:814-885-6507
Practice Address - Fax:814-885-6282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency