Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT60672813 | WA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT60672813 | WA |
NPI | 1033659131 |
---|---|
Provider Name | Ryan Mckinney |
First Address | Kennewick, WA 99338-2908 |
Second Address | Kennewick, WA 99338-2908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2017 |
Last Update Date | 21/06/2017 |