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NPI Code Detail

MEDICARE: CORY C MCKINNON P.T.

MEDICARE: CORY C MCKINNON 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
12251X0800XOrthopedic Physical Therapist9491AZ

General Provider Information

NPI Number : 1114208220
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORY C MCKINNON P.T.
Provider Business Mailing Address
First Line : 580 N CAMINO MERCADO
Second Line : SUITE 13
City : CASA GRANDE
State : AZ
Zip : 85122-5757
Country : US
Telephone Number : 520-836-8621
Fax Number :
Provider Business Practice Location Address
First Line : 580 N CAMINO MERCADO STE 13
Second Line :
City : CASA GRANDE
State : AZ
Zip : 85122-5757
Country : US
Telephone Number : 520-836-8621
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2011
Last Update Date : 10/10/2011

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Directions to “ CORY C MCKINNON P.T.” Practice Location

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