| Doctor Name: | MR. JUSTIN KELLER |
| NPI Number: | 1649315839 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT, MPT, OCS, CSCS |
| License Number: | 1129856 |
| Business Practice Address: | 1545 E Southlake Blvd Suite 100 Southlake, TX - 760926422 |
| Business Phone Number: | 8174429300 |
| Business Fax Number: | 8177960757 |
| Mailing Address: | 1545 E Southlake Blvd, Suite 100 SOUTHLAKE |
| State: | TX |
| Postal Code: | 760926422 |
| Phone Number: | 8174429300 |
| Fax Number: | 8177960757 |
| NPI Enumeration Date: | 02/21/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 1129856 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |