=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710325840
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT MCKEE PT, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2013
-----------------------------------------------------
Last Update Date | 06/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13 DEEPWATER AVE
-----------------------------------------------------
City | MASSAPEQUA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11758-8208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-317-5642
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13 DEEPWATER AVE
-----------------------------------------------------
City | MASSAPEQUA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11758-8208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-317-5642
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ROBERT MCKEE
-----------------------------------------------------
Credential | MPA PT
-----------------------------------------------------
Telephone | 516-317-5642
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------