Active NPI
Mary Hudson McKinney, DPT, NCS
- Physical Therapist
- Garden Grove, CA
National Provider Identifier
1821164898
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11688
- Practice address
- 12459 Lewis St Ste 102
Garden Grove, CA 92840-6606 - Phone
- (714) 703-8477
- NPI assigned
- Nov 28, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 11688 | CA | Primary |
Addresses
Primary practice location
12459 Lewis St Ste 102
Garden Grove, CA 92840-6606
Mailing address
12459 Lewis St Ste 102
Garden Grove, CA 92840-6606
Phone (714) 703-8477
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11688 | Other | CA | PT LICENSE |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 11688 | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Innovative Management Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapy Clinic/Center
- Garden Grove, CA
- NPI 1982722351
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1821164898",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12459 LEWIS ST STE 102",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928406606",
"telephone_number": "714-703-8477"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12459 LEWIS ST STE 102",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928406606",
"telephone_number": "714-703-8477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUDSON MCKINNEY",
"first_name": "MARY",
"name_prefix": "Mrs.",
"credential": "DPT, NCS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "11688",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PT LICENSE",
"identifier": "11688",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Garden Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.