Provider Demographics
NPI:1265504948
Name:KINNEY, PAUL RAY JR (MPT FAAO MPT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:RAY
Last Name:KINNEY
Suffix:JR
Gender:M
Credentials:MPT FAAO MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:115 NATOMA ST
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-2615
Mailing Address - Country:US
Mailing Address - Phone:916-355-8500
Mailing Address - Fax:916-355-8196
Practice Address - Street 1:115 NATOMA ST
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-2615
Practice Address - Country:US
Practice Address - Phone:916-355-8500
Practice Address - Fax:916-355-8196
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT223652251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT223650OtherBLUE SHIELD
PT22365OtherBLUE CROSS OF CA PT LIC #
PT22365OtherBLUE CROSS OF CA PT LIC #