Provider Demographics
NPI:1720515075
Name:GALPIN, KELLER WILLIAMS
Entity Type:Individual
Prefix:
First Name:KELLER
Middle Name:WILLIAMS
Last Name:GALPIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E SHOTWELL ST
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-4256
Mailing Address - Country:US
Mailing Address - Phone:229-243-8124
Mailing Address - Fax:229-243-7471
Practice Address - Street 1:1500 E SHOTWELL ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-4256
Practice Address - Country:US
Practice Address - Phone:229-243-8124
Practice Address - Fax:229-243-7471
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012486225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist