Provider Demographics
NPI:1154746675
Name:MCKELVEY, MEREDYTH (PTA)
Entity type:Individual
Prefix:
First Name:MEREDYTH
Middle Name:
Last Name:MCKELVEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 S KINGSHIGHWAY ST
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5919
Mailing Address - Country:US
Mailing Address - Phone:573-471-0110
Mailing Address - Fax:573-472-1880
Practice Address - Street 1:806 S KINGSHIGHWAY ST
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5919
Practice Address - Country:US
Practice Address - Phone:573-471-0110
Practice Address - Fax:573-472-1880
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014002152225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant