Provider Demographics
NPI:1902087216
Name:MCKINNON, ELIZABETH H (PT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:H
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7580 CHARLOTTE HWY
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7801
Mailing Address - Country:US
Mailing Address - Phone:803-548-5662
Mailing Address - Fax:
Practice Address - Street 1:7580 CHARLOTTE HWY
Practice Address - Street 2:SUITE 1100
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-7801
Practice Address - Country:US
Practice Address - Phone:803-548-5662
Practice Address - Fax:803-548-5635
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11314225100000X
SC8245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0397730034Medicare NSC