Individual provider Active NPI

Lee Ann McKinzie, PTA

  • Physical Therapy Assistant
  • Mount Vernon, IL
National Provider Identifier
1104097336
Registry record updated Mar 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
Practice address
208 Zachery Dr
Mount Vernon, IL 62864-6712
Phone
(618) 244-5580
NPI assigned
Mar 15, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 15, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X IL Primary

Addresses

Primary practice location

208 Zachery Dr
Mount Vernon, IL 62864-6712

Mailing address

7357 E Casablanca Rd
Mount Vernon, IL 62864-7342
Phone (618) 735-2828

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
160004606ILMDPhysical Therapy Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205539200000",
    "number": "1104097336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7357 E CASABLANCA RD",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628647342",
            "telephone_number": "618-735-2828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 ZACHERY DR",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646712",
            "telephone_number": "618-244-5580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKINZIE",
        "first_name": "LEE",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-03-15",
        "last_updated": "2008-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.