Provider Demographics
NPI:1407078207
Name:KELLER, VICTORIA CLARKE (PT)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:CLARKE
Last Name:KELLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:VICTORIA
Other - Middle Name:CLARKE
Other - Last Name:CANNELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:519 ELM ST
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450-3037
Mailing Address - Country:US
Mailing Address - Phone:940-521-0800
Mailing Address - Fax:
Practice Address - Street 1:519 ELM ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-3037
Practice Address - Country:US
Practice Address - Phone:940-521-0800
Practice Address - Fax:940-521-0801
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1035434225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist