Provider Demographics
NPI:1215542121
Name:MCILVAIN, GARY E (ATC)
Entity Type:Individual
Prefix:PROF
First Name:GARY
Middle Name:E
Last Name:MCILVAIN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 JOHN MARSHALL DRIVE GULLICKSON HALL 112
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25755-0001
Mailing Address - Country:US
Mailing Address - Phone:304-696-2930
Mailing Address - Fax:304-696-2928
Practice Address - Street 1:1 JOHN MARSHALL DRIVE GULLICKSON HALL 1
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25755-0001
Practice Address - Country:US
Practice Address - Phone:304-696-2930
Practice Address - Fax:304-696-2928
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer