Provider Demographics
NPI:1649721440
Name:MCKINNEY, THOMAS (PTA)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 PORT LN
Mailing Address - Street 2:SUITE #1
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2470
Mailing Address - Country:US
Mailing Address - Phone:807-676-8515
Mailing Address - Fax:
Practice Address - Street 1:1911 PORT LN
Practice Address - Street 2:SUITE #1
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2470
Practice Address - Country:US
Practice Address - Phone:807-676-8515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2027142225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant