John Mark Keller, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

40QB00359700 Issued in NJ

Practice address

16 Overhill Rd
Mount Laurel, NJ 08054-2045

Phone

(609) 757-2527

NPI assigned

Nov 13, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1699833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699833600000",
    "number": "1659145209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 ARK RD",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080543100",
            "telephone_number": "856-553-1151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 OVERHILL RD",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080542045",
            "telephone_number": "609-757-2527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "JOHN",
        "middle_name": "MARK",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-11-13",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapy Assistant",
            "state": "NJ",
            "license": "40QB00359700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine L Katzin
• Michael S. Kaufman, M.D.
• Sarah Kautz, LCSW
• Pamela Bampton Kawano, PSY.D
• April Lynn Kay, LAC
• Kendall Keller
• Joshua Kellerman, M.D.
• Gerry Joseph Kelly, PT
• Mary Jo Anne Kelly, PMHNP-BC
• Meghan Patricia Kelly, NP

• Physical Therapy Assistant in Mount Laurel, NJ
• Providers in Mount Laurel, NJ by specialty
• Physical Therapy Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.