Provider Demographics
NPI:1861459299
Name:KEELER, KIM L (PTA)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:L
Last Name:KEELER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SOUTH ST
Mailing Address - Street 2:BOW PHYSICAL THERAPY AND SPINE CENTER
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304
Mailing Address - Country:US
Mailing Address - Phone:603-224-5883
Mailing Address - Fax:603-224-6042
Practice Address - Street 1:501 SOUTH ST
Practice Address - Street 2:BOW PHYSICAL THERAPY AND SPINE CENTER
Practice Address - City:BOW
Practice Address - State:NH
Practice Address - Zip Code:03304
Practice Address - Country:US
Practice Address - Phone:603-224-5883
Practice Address - Fax:603-224-6042
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0130225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant