Healthcare Provider Details

I. General information

NPI: 1629245378
Provider Name (Legal Business Name): JUSTIN MCKINNEY P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 BROKEN SOUND PKWY STE. 500
BOCA RATON FL
33487-2773
US

IV. Provider business mailing address

PO BOX 367
HERKIMER NY
13350-0367
US

V. Phone/Fax

Practice location:
  • Phone: 561-367-1175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7424
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: