Provider Demographics
NPI:1669523023
Name:MCKINNEY, JOHN ALEXANDER (MS, PT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ALEXANDER
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:MR
Other - First Name:J.
Other - Middle Name:ALEX
Other - Last Name:MCKINNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, PT
Mailing Address - Street 1:250 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-2436
Mailing Address - Country:US
Mailing Address - Phone:508-285-5533
Mailing Address - Fax:508-285-7977
Practice Address - Street 1:250 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766-2436
Practice Address - Country:US
Practice Address - Phone:508-285-5533
Practice Address - Fax:508-285-7977
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3474515OtherAETNA
MA0317161Medicaid
MA469362OtherTUFTS HEALTH PLAN
MAY68334OtherBCBSMA
MA0033596OtherNEIGHBORHOOD HEALTH PLAN
MA3474515OtherAETNA