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NPI Code Detail

MEDICARE: EVELYN ANNA MCKAY PHYSICAL THERAPIST

MEDICARE: EVELYN ANNA MCKAY PHYSICAL THERAPIST
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
1225100000XPhysical Therapist002115CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1080002115CT02OTHERCTBLUE CARE HEALTH PLAN INS
211243520OTHERCTCAQH ID

General Provider Information

NPI Number : 1730203985
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVELYN ANNA MCKAY PHYSICAL THERAPIST
Provider Business Mailing Address
First Line : 73 WERKING ST
Second Line :
City : PLANTSVILLE
State : CT
Zip : 06479-1630
Country : US
Telephone Number : 860-621-8638
Fax Number :
Provider Business Practice Location Address
First Line : 45 MERIDEN AVE
Second Line :
City : SOUTHINGTON
State : CT
Zip : 06489-3214
Country : US
Telephone Number : 860-378-1265
Fax Number : 860-378-1160
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2007
Last Update Date : 07/08/2007

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