Provider Demographics
NPI:1669019550
Name:MCKENNA, PATRICIA
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 RAINBOW CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE LURE
Mailing Address - State:NC
Mailing Address - Zip Code:28746-0239
Mailing Address - Country:US
Mailing Address - Phone:864-621-3741
Mailing Address - Fax:
Practice Address - Street 1:1048 RAINBOW CIR
Practice Address - Street 2:
Practice Address - City:LAKE LURE
Practice Address - State:NC
Practice Address - Zip Code:28746-0239
Practice Address - Country:US
Practice Address - Phone:864-621-3741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP13102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist