Provider Demographics
NPI:1346234820
Name:MCNAMARA, KEVIN F (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:F
Last Name:MCNAMARA
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S BUCKINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47396-9296
Mailing Address - Country:US
Mailing Address - Phone:765-759-8968
Mailing Address - Fax:
Practice Address - Street 1:1100 S TIGER DR
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:IN
Practice Address - Zip Code:47396-9313
Practice Address - Country:US
Practice Address - Phone:765-759-2612
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN360002612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer