Provider Demographics
NPI:1598168536
Name:MCKINNEY, JOHN LUC (PTA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LUC
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3794 DOMINIC CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-9495
Mailing Address - Country:US
Mailing Address - Phone:513-587-9220
Mailing Address - Fax:
Practice Address - Street 1:3794 DOMINIC CT
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-9495
Practice Address - Country:US
Practice Address - Phone:513-587-9220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-05
Last Update Date:2014-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08983225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant