Provider Demographics
NPI:1295227999
Name:KELLER, AMELIA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:
Other - Last Name:DAHLHAUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1412 A AVE W STE A
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-1970
Mailing Address - Country:US
Mailing Address - Phone:641-676-3535
Mailing Address - Fax:
Practice Address - Street 1:1412 A AVE W STE A
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-1970
Practice Address - Country:US
Practice Address - Phone:641-676-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA092214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA092214OtherIOWA BOARD OF PHYSICAL THERAPY