Provider Demographics
NPI:1114594272
Name:MCKINLEY, CAROLINE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CARLIE
Other - Middle Name:
Other - Last Name:MCKINLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1014 N NOLAN RIVER RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7936
Mailing Address - Country:US
Mailing Address - Phone:817-641-8617
Mailing Address - Fax:817-641-8620
Practice Address - Street 1:1014 N NOLAN RIVER RD UNIT A
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7936
Practice Address - Country:US
Practice Address - Phone:817-641-8617
Practice Address - Fax:817-641-8620
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1346533225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist