Provider Demographics
NPI:1104308857
Name:KELLER, SMILJANA (PTA)
Entity type:Individual
Prefix:
First Name:SMILJANA
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 TAMARACK LN
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-1411
Mailing Address - Country:US
Mailing Address - Phone:940-735-2688
Mailing Address - Fax:
Practice Address - Street 1:3511 CORINTH PKWY
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76208-5384
Practice Address - Country:US
Practice Address - Phone:940-270-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2112571225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant