Provider Demographics
NPI:1861438038
Name:KINNE, MICHAEL SCOTT (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SCOTT
Last Name:KINNE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:4730 CHACE LANDING CIRCLE
Practice Address - Street 2:SUITE 124
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244
Practice Address - Country:US
Practice Address - Phone:205-730-3189
Practice Address - Fax:205-905-6212
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14501225100000X
ALPTH4021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51525714OtherBLUE CROSS & BLUE SHIELD
AL51525713OtherBLUE CROSS & BLUE SHIELD
Q34979Medicare UPIN
AL51525714OtherBLUE CROSS & BLUE SHIELD