Healthcare Provider Details

I. General information

NPI: 1043145915
Provider Name (Legal Business Name): ALYSSA JORDAN MCKAY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1552 COUNTRY CLUB PLAZA DR UNIT 1570
SAINT CHARLES MO
63303-3859
US

IV. Provider business mailing address

3 APPALOOSA TRAIL CT
SAINT PETERS MO
63376-3789
US

V. Phone/Fax

Practice location:
  • Phone: 636-724-1127
  • Fax:
Mailing address:
  • Phone: 314-556-3798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2026024927
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: