Provider Demographics
NPI:1811153208
Name:MCKINNON, JON SEVEN (LMT)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:SEVEN
Last Name:MCKINNON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1619 FOURAKER RD
Mailing Address - Street 2:
Mailing Address - City:JAX
Mailing Address - State:FL
Mailing Address - Zip Code:32221-5724
Mailing Address - Country:US
Mailing Address - Phone:904-783-1855
Mailing Address - Fax:904-783-1855
Practice Address - Street 1:1619 FOURAKER RD
Practice Address - Street 2:
Practice Address - City:JAX
Practice Address - State:FL
Practice Address - Zip Code:32221-5724
Practice Address - Country:US
Practice Address - Phone:904-783-1855
Practice Address - Fax:904-783-1855
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA6546225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist