Provider Demographics
NPI:1922435569
Name:KELLER, CAITLIN MERINGOLO (DPT)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MERINGOLO
Last Name:KELLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:MERINGOLO
Other - Last Name:SEMMELROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20414 SPRING ROSE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-7282
Mailing Address - Country:US
Mailing Address - Phone:860-908-2578
Mailing Address - Fax:
Practice Address - Street 1:20414 SPRING ROSE DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-7282
Practice Address - Country:US
Practice Address - Phone:860-908-2578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1235841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist