Provider Demographics
NPI:1295168391
Name:MCKINNEY, MAXWELL LANGDON (PT)
Entity type:Individual
Prefix:
First Name:MAXWELL
Middle Name:LANGDON
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16016 BOONES FERRY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4353
Mailing Address - Country:US
Mailing Address - Phone:503-882-2351
Mailing Address - Fax:503-882-2348
Practice Address - Street 1:16016 BOONES FERRY RD STE 101
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4353
Practice Address - Country:US
Practice Address - Phone:503-882-2351
Practice Address - Fax:503-882-2348
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02611225100000X
ORPT61383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist