Individual
MRS. TERESA LYNN KELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
8481 HOLLY ROAD, GRAND BLANC, MI 48439
(810) 694-1711
Mailing address
6088 LINCOLN BLVD, GRAND BLANC, MI 48439-5050
(810) 695-9751
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502001729
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5502001729
DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS
MI
Enumeration date
07/22/2013
Last updated
07/25/2013
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