Provider Demographics
NPI:1174873889
Name:MCKEON, PATRICK MULLEN (PTA)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:MULLEN
Last Name:MCKEON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 PARK DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NE
Mailing Address - Zip Code:68059-6845
Mailing Address - Country:US
Mailing Address - Phone:402-253-3079
Mailing Address - Fax:
Practice Address - Street 1:880 PARK DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NE
Practice Address - Zip Code:68059-6845
Practice Address - Country:US
Practice Address - Phone:402-253-3079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1142225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant