Provider Demographics
NPI:1477518553
Name:MCQUEENEY, SEAN MICHAEL (MPT, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:MICHAEL
Last Name:MCQUEENEY
Suffix:
Gender:M
Credentials:MPT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11950 W FLORES DR
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-4304
Mailing Address - Country:US
Mailing Address - Phone:623-466-8348
Mailing Address - Fax:
Practice Address - Street 1:15707 N 83RD AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3827
Practice Address - Country:US
Practice Address - Phone:623-776-4854
Practice Address - Fax:623-776-4826
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ66292251S0007X
AZ05502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer