Provider Demographics
NPI:1851728398
Name:MCKINSTRY, JAMIE LYNN EDWARDS (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LYNN EDWARDS
Last Name:MCKINSTRY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-6148
Mailing Address - Country:US
Mailing Address - Phone:315-326-0056
Mailing Address - Fax:315-326-0102
Practice Address - Street 1:364 EAST AVE
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126
Practice Address - Country:US
Practice Address - Phone:315-326-0056
Practice Address - Fax:315-326-0102
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036539-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04055703Medicaid