Provider Demographics
NPI:1902867815
Name:MCKINLEY, WAYNE KEITH
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:KEITH
Last Name:MCKINLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HIGHLANDS DR
Mailing Address - Street 2:STE 100
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543
Mailing Address - Country:US
Mailing Address - Phone:717-625-2228
Mailing Address - Fax:717-625-0959
Practice Address - Street 1:100 HIGHLANDS DR
Practice Address - Street 2:HARTZ PHYSICAL THERAPY STE 100
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543
Practice Address - Country:US
Practice Address - Phone:717-625-2228
Practice Address - Fax:717-625-0959
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002982L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist