Provider Demographics
NPI:1568492064
Name:MCKINDLEY, MICHAEL KENNETH (DPT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KENNETH
Last Name:MCKINDLEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 W. WILSON ST.
Mailing Address - Street 2:SUITE #202
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627
Mailing Address - Country:US
Mailing Address - Phone:949-631-0125
Mailing Address - Fax:949-631-0127
Practice Address - Street 1:129 W. WILSON ST.
Practice Address - Street 2:SUITE #202
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627
Practice Address - Country:US
Practice Address - Phone:949-631-0125
Practice Address - Fax:949-631-0127
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT25272BMedicare ID - Type Unspecified