Provider Demographics
NPI:1508093295
Name:MCKINNON, KRISTIN KAY (PT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:KAY
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2945
Mailing Address - Country:US
Mailing Address - Phone:830-816-4357
Mailing Address - Fax:830-331-8718
Practice Address - Street 1:1510 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2945
Practice Address - Country:US
Practice Address - Phone:830-816-4357
Practice Address - Fax:830-331-8718
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1127710225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1013348788OtherGROUP NPI