Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Jacob Kelley Frederick, DPT

Individual provider Physical Therapist · NPI 1124811393

Dr. Jacob Kelley Frederick, DPT is a Physical Therapist in O Fallon, Missouri. Licensed in Missouri. Registered with an NPI since 2025.

Licensed in
MO
In the registry since
2025
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

See every abbreviation used in this directory →

Practice location Address checks out

3074 Winghaven Blvd
O Fallon, MO 63368-3620
Phone: (636) 265-4100
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 2025017762 (MO)

Record details

NPI number1124811393
Entity typeIndividual (Type 1)
GenderMale
Credentials DPT
Sole proprietorNo
NPI enumeratedMay 28, 2025
Last updated in NPPESMay 28, 2025
Certification dateMay 28, 2025
Mailing address3513 Brookside Crossing Dr, Saint Charles, MO 63301-4901

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