Provider Demographics
NPI:1598051344
Name:MCKINNON, JENNIFER JANE ALLEN (PT, LMP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:JANE ALLEN
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:PT, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 NE 57TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2239
Mailing Address - Country:US
Mailing Address - Phone:206-612-7139
Mailing Address - Fax:
Practice Address - Street 1:3606 NE 57TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2239
Practice Address - Country:US
Practice Address - Phone:206-612-7139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008448225100000X
WAMA00007545225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist