Healthcare Provider Details

I. General information

NPI: 1659203388
Provider Name (Legal Business Name): ROBERT JOSEPH KILLION MS,LAT,ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 COACH LIGHT LN
HAZELWOOD MO
63042-3427
US

IV. Provider business mailing address

744 COACH LIGHT LN
HAZELWOOD MO
63042-3427
US

V. Phone/Fax

Practice location:
  • Phone: 636-255-4059
  • Fax:
Mailing address:
  • Phone: 636-255-4059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2019012951
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: