Provider Demographics
NPI:1306491063
Name:MCKEON, PATRICK OWEN (PHD, ATC, CSCS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:OWEN
Last Name:MCKEON
Suffix:
Gender:M
Credentials:PHD, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HILL CENTER G66
Mailing Address - Street 2:953 SOUTH DANBY RD.
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-274-1455
Mailing Address - Fax:
Practice Address - Street 1:HILL CENTER G66
Practice Address - Street 2:953 SOUTH DANBY RD.
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-274-1455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0003202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer