Provider Demographics
NPI:1386254944
Name:MCKEOWN, ADDISON T (DPT)
Entity type:Individual
Prefix:DR
First Name:ADDISON
Middle Name:T
Last Name:MCKEOWN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6604 ROBERTA RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-9532
Mailing Address - Country:US
Mailing Address - Phone:704-455-1172
Mailing Address - Fax:
Practice Address - Street 1:6604 ROBERTA RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-9532
Practice Address - Country:US
Practice Address - Phone:704-455-1172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2025-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19745225100000X
SC1386254944225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP19745OtherNC LICENSE