Provider Demographics
NPI:1992155493
Name:MCKINNEY, KELLI (PT, DPT)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 WESTPORT RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2949
Mailing Address - Country:US
Mailing Address - Phone:270-763-8225
Mailing Address - Fax:270-763-8125
Practice Address - Street 1:529 WESTPORT RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2949
Practice Address - Country:US
Practice Address - Phone:270-763-8225
Practice Address - Fax:270-763-8125
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist