Provider Demographics
NPI:1326607185
Name:KELLER, BRANNIGAN RILEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRANNIGAN
Middle Name:RILEY
Last Name:KELLER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BRANNIGAN
Other - Middle Name:ALESHA
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:199 N BROOKMOORE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2024
Mailing Address - Country:US
Mailing Address - Phone:662-327-6705
Mailing Address - Fax:662-327-6760
Practice Address - Street 1:104 CHELSEA POINT DR
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:AL
Practice Address - Zip Code:35043-4100
Practice Address - Country:US
Practice Address - Phone:205-453-9400
Practice Address - Fax:205-453-9410
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26143225100000X
ALPTH62312251G0304X, 2251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics