Provider Demographics
NPI:1609986546
Name:MCTAGUE, EDWARD MICHAEL (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:MICHAEL
Last Name:MCTAGUE
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17325 BELL NORTH DR
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-3368
Mailing Address - Country:US
Mailing Address - Phone:888-590-4002
Mailing Address - Fax:
Practice Address - Street 1:204 S INTERSTATE 35
Practice Address - Street 2:STE: 203
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-4126
Practice Address - Country:US
Practice Address - Phone:512-863-7761
Practice Address - Fax:512-863-0973
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1216710225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA28867OtherLICENSE #