Provider Demographics
NPI:1578760971
Name:MCKINLEY, SYLVIA MARY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:MARY
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17132 ROY ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-1345
Mailing Address - Country:US
Mailing Address - Phone:708-921-5535
Mailing Address - Fax:
Practice Address - Street 1:1000 114TH ST
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:IN
Practice Address - Zip Code:46394-1048
Practice Address - Country:US
Practice Address - Phone:219-659-2770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001816A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant