Provider Demographics
NPI:1043848674
Name:MCKEOWN, MATTHEW TYLER (DPT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:TYLER
Last Name:MCKEOWN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 ROCK SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:WILMAR
Mailing Address - State:AR
Mailing Address - Zip Code:71675-7112
Mailing Address - Country:US
Mailing Address - Phone:870-224-2675
Mailing Address - Fax:870-460-4860
Practice Address - Street 1:778 SCOGIN DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-5729
Practice Address - Country:US
Practice Address - Phone:870-460-3540
Practice Address - Fax:870-460-4860
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT4691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist