Provider Demographics
NPI:1730754094
Name:MCKINNEY, PAYTON MADALYN (DPT)
Entity type:Individual
Prefix:
First Name:PAYTON
Middle Name:MADALYN
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5264 FALLWORTH CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-5902
Mailing Address - Country:US
Mailing Address - Phone:806-778-4794
Mailing Address - Fax:
Practice Address - Street 1:5310 ACTON HWY STE 106
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-3105
Practice Address - Country:US
Practice Address - Phone:137-581-7326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3126518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty