Provider Demographics
NPI:1154490662
Name:MCKENNA, CYNTHIA A (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:A
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 N CORINTH ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76208-5448
Mailing Address - Country:US
Mailing Address - Phone:940-497-3003
Mailing Address - Fax:940-497-9153
Practice Address - Street 1:2606 BRANDI LN
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76210-1625
Practice Address - Country:US
Practice Address - Phone:940-497-3003
Practice Address - Fax:940-497-9153
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1034992081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine