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NPI Code Detail

MEDICARE: MRS. KELLY SMITH MCCLINTON PT

MEDICARE: MRS. KELLY SMITH MCCLINTON PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistIL

General Provider Information

NPI Number : 1558410431
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY SMITH MCCLINTON PT
Provider Business Mailing Address
First Line : 1520 CALEB CT
Second Line :
City : SWANSEA
State : IL
Zip : 62226-2477
Country : US
Telephone Number : 618-277-6233
Fax Number :
Provider Business Practice Location Address
First Line : 4500 MEMORIAL DR
Second Line :
City : BELLEVILLE
State : IL
Zip : 62226-5399
Country : US
Telephone Number : 618-257-5265
Fax Number : 618-257-6929
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2007
Last Update Date : 06/07/2026

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