Provider Demographics
NPI:1396944815
Name:KELLER, WILLIAM JOSEPH (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:KELLER
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-6002
Mailing Address - Country:US
Mailing Address - Phone:504-913-0487
Mailing Address - Fax:
Practice Address - Street 1:202 MCALISTER EXT
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5671
Practice Address - Country:US
Practice Address - Phone:504-864-2125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAATH.2000592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAATH.200059OtherLOUISIANA