MEDICARE: KELLY J MCKEON DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2019003998	MO

General Provider Information

NPI Number	:	1457823064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY J MCKEON DPT

Provider Business Mailing Address
First Line	:	647 SPIRIT AIRPARK WEST DR STE 101
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63005-1032
Country	:	US
Telephone Number	:	636-223-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 FORUM BLVD STE 1C
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-1997
Country	:	US
Telephone Number	:	573-810-5703
Fax Number	:	934-649-4710

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2018
Last Update Date	:	04/16/2026

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