Provider Demographics
NPI:1003845348
Name:MCKINNEY, JUSTIN WAYNE (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:WAYNE
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BENT TREE CT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2057
Mailing Address - Country:US
Mailing Address - Phone:615-453-8262
Mailing Address - Fax:
Practice Address - Street 1:1616 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3100
Practice Address - Country:US
Practice Address - Phone:615-443-6818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer