Provider Demographics
NPI:1003940172
Name:MCGAUGHEY, KELLEY M (PT)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:M
Last Name:MCGAUGHEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15425 MANCHESTER RD
Mailing Address - Street 2:STE. 28
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3077
Mailing Address - Country:US
Mailing Address - Phone:636-220-6969
Mailing Address - Fax:636-220-6973
Practice Address - Street 1:15425 MANCHESTER RD
Practice Address - Street 2:STE.28
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-3077
Practice Address - Country:US
Practice Address - Phone:636-220-6969
Practice Address - Fax:636-220-6973
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011000807225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist