Provider Demographics
NPI:1346015963
Name:MCKINNEY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MCKINNEY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:828-729-5387
Mailing Address - Street 1:1310 RAINDAGGER DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-6557
Mailing Address - Country:US
Mailing Address - Phone:828-729-5387
Mailing Address - Fax:
Practice Address - Street 1:250 S MCCORMICK ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4714
Practice Address - Country:US
Practice Address - Phone:828-729-5387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-24
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy