Sally Martha McKanna

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

160004478 Issued in IL

Practice address

5533 N Galena Rd
Peoria Heights, IL 61616-4447

Phone

(309) 682-5428

NPI assigned

Dec 7, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

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": "1638835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638835200000",
    "number": "1588322465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1590 COUNTY ROAD 425 E",
            "city": "METAMORA",
            "state": "IL",
            "postal_code": "615487835",
            "telephone_number": "815-263-2517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5533 N GALENA RD",
            "city": "PEORIA HEIGHTS",
            "state": "IL",
            "postal_code": "616164447",
            "telephone_number": "309-682-5428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKANNA",
        "first_name": "SALLY",
        "middle_name": "MARTHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-07",
        "last_updated": "2021-12-07",
        "certification_date": "2021-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160004478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Metamora",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5533 N Galena Rd",
            "city": "Peoria Heights",
            "state": "IL",
            "country_code": "US",
            "postal_code": "616164447",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Metamora",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5533 N Galena Rd",
            "city": "Peoria Heights",
            "state": "IL",
            "country_code": "US",
            "postal_code": "616164447",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Renee Elizabeth Landin, M.A. CCC-SLP
• Lisa Schwab, LLC
• Aline Malebranche, M.D.
• Virginia Mattern
• Maxim Healthcare Services, Inc.
• Elizabeth Amelia McWhirter, COTA/L
• Midwest Health Operations, LLC
• Mark Montefolka, MD
• Ioan Mosoiu, MD
• Cristina Lynn Mugrage, MSW

• Physical Therapy Assistant in Peoria Heights, IL
• Providers in Peoria Heights, IL by specialty
• Physical Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2021; 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.