Provider Demographics
NPI:1366884132
Name:MCGEHEE, MICHAEL OWEN (PTA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:OWEN
Last Name:MCGEHEE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1435
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71657-1435
Mailing Address - Country:US
Mailing Address - Phone:479-561-2985
Mailing Address - Fax:
Practice Address - Street 1:4423 S 22ND ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-8011
Practice Address - Country:US
Practice Address - Phone:479-561-2985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA2613225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant