Provider Demographics
NPI:1497268668
Name:MCKINNEY, BRANDON ALAN (DPT, PT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:ALAN
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 UPPINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-6552
Mailing Address - Country:US
Mailing Address - Phone:520-241-7332
Mailing Address - Fax:
Practice Address - Street 1:880 APOLLO ST STE 160
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4785
Practice Address - Country:US
Practice Address - Phone:310-606-5664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist