Provider Demographics
NPI:1326367558
Name:MCGAHAN, BRENDA G (PT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:G
Last Name:MCGAHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PINE CT
Mailing Address - Street 2:
Mailing Address - City:KENOVA
Mailing Address - State:WV
Mailing Address - Zip Code:25530-9678
Mailing Address - Country:US
Mailing Address - Phone:304-453-1997
Mailing Address - Fax:304-453-1997
Practice Address - Street 1:11 PINE CT
Practice Address - Street 2:
Practice Address - City:KENOVA
Practice Address - State:WV
Practice Address - Zip Code:25530-9678
Practice Address - Country:US
Practice Address - Phone:304-453-1997
Practice Address - Fax:304-453-1997
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV000152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist