Provider Demographics
NPI:1346410917
Name:MCKINLEY, NICOLLE DANIELE (PT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLLE
Middle Name:DANIELE
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:NICOLLE
Other - Middle Name:DANIELE
Other - Last Name:FERRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5000 ROCKSIDE RD STE 500
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2178
Mailing Address - Country:US
Mailing Address - Phone:216-459-2846
Mailing Address - Fax:216-901-2803
Practice Address - Street 1:5520 BROADVIEW RD FRNT
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-1605
Practice Address - Country:US
Practice Address - Phone:216-749-6650
Practice Address - Fax:216-749-1655
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT013113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0212058Medicaid
OH12219864OtherCAQH