Basic Information
| Provider Information | |||||||||
| NPI: | 1831866706 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEELER | ||||||||
| FirstName: | LOREN | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4138 MCSWEENEY RD | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN IRON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557688000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182087045 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 750 E 34TH ST | ||||||||
| Address2: | |||||||||
| City: | HIBBING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557462341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182624881 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2021 | ||||||||
| LastUpdateDate: | 08/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146L00000X | 995660 | MN | N | Emergency Medical Service Providers | Emergency Medical Technician, Paramedic | 225100000X | 12395 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.