Provider Demographics
NPI:1497739031
Name:MCKINNON, JOHN L (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:MCKINNON
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 1:1111 W WELLESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-1274
Mailing Address - Country:US
Mailing Address - Phone:509-448-9358
Mailing Address - Fax:
Practice Address - Street 1:1111 W WELLESLEY AVE
Practice Address - Street 2:FOUR SEASONS PHYSICAL THERAPY
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-1274
Practice Address - Country:US
Practice Address - Phone:509-327-1578
Practice Address - Fax:509-327-1596
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAR12248OtherL AND I
WA7022700Medicaid
WA8345837Medicaid
WA8345837Medicaid