Provider Demographics
NPI:1356301907
Name:MCEACHRAN, MARC R (MPT)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:R
Last Name:MCEACHRAN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5604 E ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217-9743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1111 E WESTVIEW CT
Practice Address - Street 2:SUITE A
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1376
Practice Address - Country:US
Practice Address - Phone:509-465-1749
Practice Address - Fax:509-465-1748
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008105225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0160479OtherLABOR & INDUSTRIES
WA8348195Medicaid
WAAB20165Medicare ID - Type Unspecified