Provider Demographics
NPI:1023644077
Name:MCKINNEY, TAYLOR E (ATC,LAT)
Entity type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:E
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:ATC,LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10124 BURTRUM DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-1639
Mailing Address - Country:US
Mailing Address - Phone:704-618-0973
Mailing Address - Fax:
Practice Address - Street 1:3451 BONDS RANCH RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-6804
Practice Address - Country:US
Practice Address - Phone:817-847-2946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT76512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer