Provider Demographics
NPI:1881402675
Name:MCKINDLEY, ELIZABETH (ATC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MCKINDLEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12409 LARGO DR APT 233
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-2039
Mailing Address - Country:US
Mailing Address - Phone:714-343-3692
Mailing Address - Fax:
Practice Address - Street 1:12409 LARGO DR APT 233
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-2039
Practice Address - Country:US
Practice Address - Phone:714-343-3692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-25
Last Update Date:2024-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0045622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer