Provider Demographics
NPI:1215047998
Name:MCKINNEY, KATHLEEN
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15206 FALCON DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-6362
Mailing Address - Country:US
Mailing Address - Phone:512-659-7562
Mailing Address - Fax:
Practice Address - Street 1:12700 SHOPS PKWY
Practice Address - Street 2:450
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-6597
Practice Address - Country:US
Practice Address - Phone:512-263-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1165759OtherLICENSE