Provider Demographics
NPI:1578869749
Name:MCEWEN, EDWARD ALLEN (PT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ALLEN
Last Name:MCEWEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23995 N 2200TH RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:61470-8483
Mailing Address - Country:US
Mailing Address - Phone:309-333-8535
Mailing Address - Fax:
Practice Address - Street 1:23995 N 2200TH RD
Practice Address - Street 2:
Practice Address - City:PRAIRIE CITY
Practice Address - State:IL
Practice Address - Zip Code:61470-8483
Practice Address - Country:US
Practice Address - Phone:309-333-8535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.008503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist