MEDICARE: MRS. ELIZABETH H MCKINNON PT

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	11314	NC
2	225100000X	Physical Therapist	8245	SC

General Provider Information

NPI Number	:	1902087216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH H MCKINNON PT

Provider Business Mailing Address
First Line	:	7580 CHARLOTTE HWY
Second Line	:	SUITE 1100
City	:	INDIAN LAND
State	:	SC
Zip	:	29707-7801
Country	:	US
Telephone Number	:	803-548-5662
Fax Number	:

Provider Business Practice Location Address
First Line	:	7580 CHARLOTTE HWY
Second Line	:	SUITE 1100
City	:	INDIAN LAND
State	:	SC
Zip	:	29707-7801
Country	:	US
Telephone Number	:	803-548-5662
Fax Number	:	803-548-5635

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

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	07/15/2016

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