Provider Demographics
NPI:1770869299
Name:MCKINLEY, GENE C (LAT, ATC)
Entity type:Individual
Prefix:
First Name:GENE
Middle Name:C
Last Name:MCKINLEY
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 BOWER DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77611-2924
Mailing Address - Country:US
Mailing Address - Phone:409-735-1642
Mailing Address - Fax:409-735-1638
Practice Address - Street 1:350 BOWER DR
Practice Address - Street 2:
Practice Address - City:BRIDGE CITY
Practice Address - State:TX
Practice Address - Zip Code:77611-2924
Practice Address - Country:US
Practice Address - Phone:409-735-1642
Practice Address - Fax:409-735-1638
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT06112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer