Provider Demographics
NPI:1114334448
Name:MCKINNON, KATHRYN (DPT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10809 S SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7033
Mailing Address - Country:US
Mailing Address - Phone:810-695-8700
Mailing Address - Fax:810-695-7946
Practice Address - Street 1:3562 S LAPEER RD STE F
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:MI
Practice Address - Zip Code:48455-8998
Practice Address - Country:US
Practice Address - Phone:810-212-1277
Practice Address - Fax:810-695-7946
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501016518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist