Provider Demographics
NPI:1568186880
Name:KELLER, DANIEL NORMAN (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:NORMAN
Last Name:KELLER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CAYUGA AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-2303
Mailing Address - Country:US
Mailing Address - Phone:631-455-7015
Mailing Address - Fax:
Practice Address - Street 1:400 W MAIN ST STE 340
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3009
Practice Address - Country:US
Practice Address - Phone:631-661-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0489412251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic