Provider Demographics
NPI:1881998599
Name:KELLER, GEOFFREY R
Entity type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:R
Last Name:KELLER
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 1:45 FRANKLIN ST
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-1334
Mailing Address - Country:US
Mailing Address - Phone:617-542-6611
Mailing Address - Fax:617-542-0161
Practice Address - Street 1:45 FRANKLIN ST
Practice Address - Street 2:FLOOR 2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-1334
Practice Address - Country:US
Practice Address - Phone:617-542-6611
Practice Address - Fax:617-542-0161
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist