Provider Demographics
NPI:1356329718
Name:MCGAVRAN, MICHELLE MARGARET (MSPT)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:MARGARET
Last Name:MCGAVRAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9043 RENNER BLVD
Mailing Address - Street 2:APT. 1908
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-3004
Mailing Address - Country:US
Mailing Address - Phone:816-241-2131
Mailing Address - Fax:
Practice Address - Street 1:1931 BURLINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3407
Practice Address - Country:US
Practice Address - Phone:816-241-2131
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004014094225100000X
KS11-03303225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist