MEDICARE: KATHRYN MCKINNON DPT

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	5501016518	MI

General Provider Information

NPI Number	:	1114334448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN MCKINNON DPT

Provider Business Mailing Address
First Line	:	10809 S SAGINAW ST
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-7033
Country	:	US
Telephone Number	:	810-695-8700
Fax Number	:	810-695-7946

Provider Business Practice Location Address
First Line	:	3562 S LAPEER RD STE F
Second Line	:
City	:	METAMORA
State	:	MI
Zip	:	48455-8998
Country	:	US
Telephone Number	:	810-212-1277
Fax Number	:	810-695-7946

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

Provider Enumeration Date	:	07/18/2014
Last Update Date	:	03/23/2024

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