DR. Jacob Kelley Frederick, DPT

NPI #1124811393 in O Fallon, Missouri

Provider Information

NPI Number: 1124811393
Entity Type: Individual
Name: DR. Jacob Kelley Frederick, DPT
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapist
Credential: DPT
Enumeration Date: May 28, 2025
Last Updated: May 28, 2025

Practice Location

Address: 3074 WINGHAVEN BLVD
City: O Fallon
State: Missouri
ZIP Code: 63368-3620
Phone: (636) 265-4100

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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