Provider Demographics
NPI:1093006355
Name:MCKEAN, THOMAS (RPT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:MCKEAN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 DIANE DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-8531
Mailing Address - Country:US
Mailing Address - Phone:561-715-6349
Mailing Address - Fax:
Practice Address - Street 1:3625 DIANE DR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-8531
Practice Address - Country:US
Practice Address - Phone:561-715-6349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT19612OtherSTATE OF FLORIDA PHYSICAL THERAPIST