Provider Demographics
NPI:1114318490
Name:KELLER, BRADLEY (RRT)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:KELLER
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-2512
Mailing Address - Country:US
Mailing Address - Phone:724-972-6912
Mailing Address - Fax:
Practice Address - Street 1:606 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-2512
Practice Address - Country:US
Practice Address - Phone:724-972-6912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAYM011443227900000X
FLRT6419227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered