Basic Information
| Provider Information | |||||||||
| NPI: | 1356555650 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLER | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | OTRL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3457 | ||||||||
| Address2: | |||||||||
| City: | CAREFREE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805952184 | ||||||||
| FaxNumber: | 4805950212 | ||||||||
| Practice Location | |||||||||
| Address1: | 17220 N BOSWELL BLVD | ||||||||
| Address2: | STE L200 | ||||||||
| City: | SUN CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239774911 | ||||||||
| FaxNumber: | 6239774919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | AZ | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.