Provider Demographics
NPI:1194823682
Name:MCGHEE, CONSTANCE J (PT)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:J
Last Name:MCGHEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12 ARTISAN LN
Mailing Address - Street 2:UNIT B
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-3223
Mailing Address - Country:US
Mailing Address - Phone:505-982-8561
Mailing Address - Fax:505-989-1740
Practice Address - Street 1:12 ARTISAN LN
Practice Address - Street 2:UNIT B
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-3223
Practice Address - Country:US
Practice Address - Phone:505-982-8561
Practice Address - Fax:505-989-1740
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM359225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMJ4287Medicaid
NM348533506Medicare PIN