Basic Information
| Provider Information | |||||||||
| NPI: | 1619406998 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KELLER | ||||||||
| FirstName: | MARRI | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 625 ENTERPRISE DR | ||||||||
| Address2: | |||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305756250 | ||||||||
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| Practice Location | |||||||||
| Address1: | 690 COPPER RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805032100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 225100000X | 13049 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1972915494 | 01 | AZ | TOPS PHYSICAL THERAPY | OTHER |