Provider Demographics
NPI:1134520588
Name:MCKINNEY, DONNIE RAY JR (PT)
Entity type:Individual
Prefix:DR
First Name:DONNIE
Middle Name:RAY
Last Name:MCKINNEY
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:6500 EASTERN AVE
Practice Address - Street 2:SUITE E & F
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2900
Practice Address - Country:US
Practice Address - Phone:410-633-3670
Practice Address - Fax:410-633-3674
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD25186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist