Healthcare Provider Details

I. General information

NPI: 1689819708
Provider Name (Legal Business Name): AMY L MCKEEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1686 LEXINGTON AVE N
ROSEVILLE MN
55113-6514
US

IV. Provider business mailing address

3500 AMERICAN BLVD W STE 300
BLOOMINGTON MN
55431-4442
US

V. Phone/Fax

Practice location:
  • Phone: 877-609-0123
  • Fax: 888-425-0398
Mailing address:
  • Phone: 952-512-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6547
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: