Provider Demographics
NPI:1215088679
Name:MCKINNEY, JESSICA LEIGH (MS, PT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LEIGH
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-2436
Mailing Address - Country:US
Mailing Address - Phone:508-285-5533
Mailing Address - Fax:508-285-7977
Practice Address - Street 1:250 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766-2436
Practice Address - Country:US
Practice Address - Phone:508-285-5533
Practice Address - Fax:508-285-7977
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3474097OtherAETNA
MA0324931Medicaid
MAY68335OtherBCBS MA PHYSICAL THERAPY
MA469375OtherTUFTS HEALTH PLAN
MA0033590OtherNEIGHBORHOOD HEALTH PLAN
MA0324931Medicaid