Provider Demographics
NPI:1831866706
Name:KEELER, LOREN THOMAS JR (DPT)
Entity type:Individual
Prefix:DR
First Name:LOREN
Middle Name:THOMAS
Last Name:KEELER
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4138 MCSWEENEY RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN IRON
Mailing Address - State:MN
Mailing Address - Zip Code:55768-8000
Mailing Address - Country:US
Mailing Address - Phone:218-208-7045
Mailing Address - Fax:
Practice Address - Street 1:750 E 34TH ST
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2341
Practice Address - Country:US
Practice Address - Phone:218-262-4881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN995660146L00000X
MN12395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic