Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1710 |
NPI | 1639606999 |
---|---|
Provider Name | Mr. Stevenson Mckinney |
First Address | Memphis, TN 38104-2127 |
Second Address | Memphis, TN 38104-2127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2017 |
Last Update Date | 17/05/2017 |