Provider Demographics
NPI:1730795105
Name:MCKEVIE, GENE EWING
Entity type:Individual
Prefix:
First Name:GENE
Middle Name:EWING
Last Name:MCKEVIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 SEMINARY RD APT 618
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1849
Mailing Address - Country:US
Mailing Address - Phone:703-599-8817
Mailing Address - Fax:
Practice Address - Street 1:4921 SEMINARY RD APT 618
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1849
Practice Address - Country:US
Practice Address - Phone:703-599-8817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA62383225700000X
VA0019006223225700000X
DCMT0953225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist