MEDICARE: MR. JAMES WILLIAM MCKINLEY P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070010741	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	567700	OTHER	IL	MEDICARE GROUP NUMBER
3	568080	OTHER	IL	MEDICARE GROUP NUMBER
4	568150	OTHER	IL	MEDICARE GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1619908	OTHER	IL	BSBS IL GROUP

General Provider Information

NPI Number	:	1124246053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES WILLIAM MCKINLEY P.T.

Provider Business Mailing Address
First Line	:	205 W WACKER DR
Second Line	:	SUITE 1020
City	:	CHICAGO
State	:	IL
Zip	:	60606-1216
Country	:	US
Telephone Number	:	312-640-0329
Fax Number	:

Provider Business Practice Location Address
First Line	:	7474 E STATE ST
Second Line	:	SUITE 118
City	:	ROCKFORD
State	:	IL
Zip	:	61108-2644
Country	:	US
Telephone Number	:	815-397-4439
Fax Number	:	815-397-4459

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	12/02/2008

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