Basic Information
| Provider Information | |||||||||
| NPI: | 1568487437 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CULLER | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | ORTHOTIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2126 RANSOM RD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 186128205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708243521 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1111 E END BLVD | ||||||||
| Address2: | |||||||||
| City: | WILKES BARRE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187110030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708243521 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | ABCC0004397 | PA | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.