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Individual

MCKENNA MACKINTOSH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DPT

Contact information

Practice address
109 S 65TH AVE STE 105, RIDGEFIELD, WA 98642-3408
(360) 309-6189
(360) 309-6193
Mailing address
109 S 65TH AVE STE 105, RIDGEFIELD, WA 98642-3408
(360) 309-6189
(360) 309-6193

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT61069123
WA
2251X0800X
Orthopedic Physical Therapist
Primary
PT61069123
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PT61069123
PHYSICAL THERAPY LICENSE
WA
Enumeration date
09/18/2020
Last updated
09/18/2020
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