Provider Demographics
NPI:1770573628
Name:MCKINNON, LINDA C (PT)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:C
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CARRIAGE HOUSE WAY
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-2192
Mailing Address - Country:US
Mailing Address - Phone:508-533-8185
Mailing Address - Fax:508-533-5452
Practice Address - Street 1:1 CARRIAGE HOUSE WAY
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-2192
Practice Address - Country:US
Practice Address - Phone:508-533-8185
Practice Address - Fax:508-533-5452
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3392225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY66049OtherBCBS
MA0380555Medicaid
MA37935OtherHPHC