Provider Demographics
NPI:1508112236
Name:MCGEE, ROBERT JEFFERY (ATC / LAT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JEFFERY
Last Name:MCGEE
Suffix:
Gender:M
Credentials:ATC / LAT
Other - Prefix:
Other - First Name:JEFF
Other - Middle Name:
Other - Last Name:MCGEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3907 SW FLATROCK AVE.
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712
Mailing Address - Country:US
Mailing Address - Phone:479-255-8258
Mailing Address - Fax:
Practice Address - Street 1:1702 SE J ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3763
Practice Address - Country:US
Practice Address - Phone:479-225-8258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR401174400000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No174400000XOther Service ProvidersSpecialist