Provider Demographics
NPI:1316515570
Name:MCKINLEY JEFFRIES, RACHEL BROOKS (DPT)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:BROOKS
Last Name:MCKINLEY JEFFRIES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:BROOKS
Other - Last Name:MCKINLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:6301 BASS RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-9384
Mailing Address - Country:US
Mailing Address - Phone:502-228-8359
Mailing Address - Fax:
Practice Address - Street 1:6301 BASSRD
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059
Practice Address - Country:US
Practice Address - Phone:502-228-8359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007706225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY007706OtherKENTUCKY BOARD OF PHYSICAL THERAPY