Provider Demographics
NPI:1043287915
Name:KELLERSTRASS, JOHN (PT, ATC, MED)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:KELLERSTRASS
Suffix:
Gender:M
Credentials:PT, ATC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1238 CHAUCER PL
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-9750
Mailing Address - Country:US
Mailing Address - Phone:513-314-1487
Mailing Address - Fax:
Practice Address - Street 1:1553 LYONS RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-1881
Practice Address - Country:US
Practice Address - Phone:937-438-0647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-OH9128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist