Provider Demographics
NPI:1275515124
Name:MCCAIN, KELVIN L (PT)
Entity Type:Individual
Prefix:MR
First Name:KELVIN
Middle Name:L
Last Name:MCCAIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 LEE LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438-4341
Mailing Address - Country:US
Mailing Address - Phone:985-795-1746
Mailing Address - Fax:985-795-1748
Practice Address - Street 1:973 LEE ST
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-1772
Practice Address - Country:US
Practice Address - Phone:985-795-1746
Practice Address - Fax:985-796-1748
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02271225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C718Medicare ID - Type Unspecified