Healthcare Provider Details

I. General information

NPI: 1649105248
Provider Name (Legal Business Name): RYAN KELLAR DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15425 MANCHESTER RD STE 28
BALLWIN MO
63011-3077
US

IV. Provider business mailing address

15425 MANCHESTER RD STE 28
BALLWIN MO
63011-3077
US

V. Phone/Fax

Practice location:
  • Phone: 636-220-6969
  • Fax: 636-220-6973
Mailing address:
  • Phone: 636-220-6969
  • Fax: 636-220-6973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: