Healthcare Provider Details

I. General information

NPI: 1629005301
Provider Name (Legal Business Name): JOHN S MCKELL M.S., P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 E 770 N
OREM UT
84097-4101
US

IV. Provider business mailing address

504 E 770 N
OREM UT
84097-4101
US

V. Phone/Fax

Practice location:
  • Phone: 801-224-2177
  • Fax: 801-224-2195
Mailing address:
  • Phone: 801-224-2177
  • Fax: 801-224-2195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number313317-2401
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3133172401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: