Provider Demographics
NPI:1932485695
Name:KELLER, VON ARNA JR (LMT)
Entity Type:Individual
Prefix:MR
First Name:VON
Middle Name:ARNA
Last Name:KELLER
Suffix:JR
Gender:M
Credentials:LMT
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Mailing Address - Street 1:12605 EMERALD COAST PKWY W
Mailing Address - Street 2:STE 2
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-3804
Mailing Address - Country:US
Mailing Address - Phone:850-269-0820
Mailing Address - Fax:850-269-2620
Practice Address - Street 1:12605 EMERALD COAST PKWY W
Practice Address - Street 2:STE 2
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-3804
Practice Address - Country:US
Practice Address - Phone:850-269-0820
Practice Address - Fax:850-269-2620
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
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Provider Licenses
StateLicense IDTaxonomies
FLMA28901225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC1394OtherBLUE CROSS BLUE SHIELD