Provider Demographics
NPI:1902464555
Name:MCKENNA, JAMES BLAKE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BLAKE
Last Name:MCKENNA
Suffix:
Gender:M
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 1:23126 FAIRVINE PARK DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2115
Mailing Address - Country:US
Mailing Address - Phone:713-705-8662
Mailing Address - Fax:
Practice Address - Street 1:21938 ROYAL MONTREAL DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-5142
Practice Address - Country:US
Practice Address - Phone:281-944-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1318560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist