Provider Demographics
NPI:1508074972
Name:KEELE, VAN P
Entity Type:Individual
Prefix:MR
First Name:VAN
Middle Name:P
Last Name:KEELE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 NE PARK PLAZA DR
Mailing Address - Street 2:SUITE 246
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5808
Mailing Address - Country:US
Mailing Address - Phone:360-696-1070
Mailing Address - Fax:360-737-0200
Practice Address - Street 1:201 NE PARK PLAZA DR
Practice Address - Street 2:SUITE 246
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5808
Practice Address - Country:US
Practice Address - Phone:360-696-1070
Practice Address - Fax:360-737-0200
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006934208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation