Provider Demographics
NPI:1407967409
Name:KELLER, VICKI LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:LYNN
Last Name:KELLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:VICKI
Other - Middle Name:LYNN
Other - Last Name:LITZELFELNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:310 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-1456
Mailing Address - Country:US
Mailing Address - Phone:573-243-1001
Mailing Address - Fax:573-243-1401
Practice Address - Street 1:310 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-1456
Practice Address - Country:US
Practice Address - Phone:573-243-1001
Practice Address - Fax:573-243-1401
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00932225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist