Provider Demographics
NPI:1396978623
Name:MCKENNEY, MICHAEL ANTHONY (MS, ATC, NASM-CES)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:MCKENNEY
Suffix:
Gender:M
Credentials:MS, ATC, NASM-CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23R WINTER ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1120
Mailing Address - Country:US
Mailing Address - Phone:617-637-5565
Mailing Address - Fax:
Practice Address - Street 1:360 HUNTINGTON AVE
Practice Address - Street 2:107 CABOT BUILDING
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5005
Practice Address - Country:US
Practice Address - Phone:617-637-5565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer