Individual
LUCAS KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3080 E GENTRY WAY STE 180, MERIDIAN, ID 83642-3014
(208) 939-3334
Mailing address
17850 28TH ST NW, BALDWIN, ND 58521-9773
(701) 471-6016
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT-7368
ID
Other
Enumeration date
06/01/2021
Last updated
06/01/2021
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