Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 20690 | MD |
NPI | 1104383876 |
---|---|
Provider Name | Havala Mckinney |
First Address | Randallstown, MD 21133-3602 |
Second Address | Randallstown, MD 21133-3602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2019 |
Last Update Date | 28/02/2019 |