Provider Demographics
NPI:1124246053
Name:MCKINLEY, JAMES WILLIAM (PT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WILLIAM
Last Name:MCKINLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:7474 E STATE ST
Practice Address - Street 2:SUITE 118
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2644
Practice Address - Country:US
Practice Address - Phone:815-397-4439
Practice Address - Fax:815-397-4459
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619908OtherBSBS IL GROUP
IL567700OtherMEDICARE GROUP NUMBER
IL568080OtherMEDICARE GROUP NUMBER
IL568150OtherMEDICARE GROUP NUMBER
ILR00134Medicare PIN
IL1619908OtherBSBS IL GROUP
IL568150OtherMEDICARE GROUP NUMBER
ILR00135Medicare PIN