Provider Demographics
NPI:1023363702
Name:MCKINLEY, MEGAN E (PT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:E
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:E
Other - Last Name:TOMASSINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:75 JONES AND GIFFORD AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-2828
Mailing Address - Country:US
Mailing Address - Phone:716-661-1541
Mailing Address - Fax:
Practice Address - Street 1:75 JONES AND GIFFORD AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-2828
Practice Address - Country:US
Practice Address - Phone:716-661-1541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035059225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03004955Medicaid