Provider Demographics
NPI:1841325982
Name:KELLER, JO ANNE (PT)
Entity type:Individual
Prefix:
First Name:JO
Middle Name:ANNE
Last Name:KELLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 BRANDY CAMP RD
Mailing Address - Street 2:
Mailing Address - City:KERSEY
Mailing Address - State:PA
Mailing Address - Zip Code:15846-1503
Mailing Address - Country:US
Mailing Address - Phone:814-885-6507
Mailing Address - Fax:814-885-6282
Practice Address - Street 1:779 BRANDY CAMP RD
Practice Address - Street 2:
Practice Address - City:KERSEY
Practice Address - State:PA
Practice Address - Zip Code:15846-1503
Practice Address - Country:US
Practice Address - Phone:814-885-6507
Practice Address - Fax:814-885-6282
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2011-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007439L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist