Provider Demographics
NPI:1366757759
Name:KELLER, BRAD (CPTA)
Entity type:Individual
Prefix:MR
First Name:BRAD
Middle Name:
Last Name:KELLER
Suffix:
Gender:M
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 PALACE DR STE C
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-6265
Mailing Address - Country:US
Mailing Address - Phone:620-271-0700
Mailing Address - Fax:620-271-0703
Practice Address - Street 1:1800 PALACE DR
Practice Address - Street 2:SUITE C
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-6264
Practice Address - Country:US
Practice Address - Phone:620-271-0700
Practice Address - Fax:620-271-0703
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01290225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant