Provider Demographics
NPI:1740805530
Name:MCKINLEY, SUSAN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 N WILLIAMS ST APT 150
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-5697
Mailing Address - Country:US
Mailing Address - Phone:513-659-1068
Mailing Address - Fax:
Practice Address - Street 1:2110 N WILLIAMS ST APT 150
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5697
Practice Address - Country:US
Practice Address - Phone:513-659-1068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0012423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist