Devon William McKenna, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

40QB00397200 Issued in NJ

Practice address

622 Eagle Rock Ave
West Orange, NJ 07052-2994

Phone

(973) 669-0078

Fax

(973) 669-1113

NPI assigned

Oct 5, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1664928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664928000000",
    "number": "1386369189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "981 US HIGHWAY 22 FL 2",
            "city": "BRIDGEWATER",
            "state": "NJ",
            "postal_code": "088072946",
            "telephone_number": "201-801-7141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 EAGLE ROCK AVE",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070522994",
            "telephone_number": "973-669-0078",
            "fax_number": "973-669-1113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENNA",
        "first_name": "DEVON",
        "middle_name": "WILLIAM",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-05",
        "last_updated": "2022-10-05",
        "certification_date": "2022-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NJ",
            "license": "40QB00397200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Candice C McEwan, NP
• Caitlyn Marie McGowan, OTR/L
• Katherine McGuire, OTR/L
• Kimberly McGuire, PH.D.
• Carrie McKeen, R.N.
• MCRC Physical Therapy, LLC
• Jessica Lynn Meade, AGPCNP-C
• Medical Center Health Care Services, Inc
• Brooke Meelheim, DO
• Mega Care, Inc.

• Physical Therapy Assistant in West Orange, NJ
• Providers in West Orange, NJ by specialty
• Physical Therapy Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2022; 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.