Individual
MARK B MCKINLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
4710 PUDDLEDOCK RD, STE 100, PRINCE GEORGE, VA 23875-1269
(804) 732-0035
(804) 732-0045
Mailing address
1115 BOULDERS PKWY, STE 200, NORTH CHESTERFIELD, VA 23225-4067
(804) 560-5595
(804) 560-9029
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305207940
VA
225100000X
Physical Therapist
7559
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7559
LICENSE
SC
01
—
C09813
MEDICARE IDENTIFICATION NUMBER
VA
Enumeration date
03/05/2015
Last updated
10/30/2020
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