Provider Demographics
NPI:1649583840
Name:MCGEE, JEFFREY BRENNAN (PTA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BRENNAN
Last Name:MCGEE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:LA
Mailing Address - Zip Code:71358-0432
Mailing Address - Country:US
Mailing Address - Phone:337-288-8533
Mailing Address - Fax:
Practice Address - Street 1:119 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5143
Practice Address - Country:US
Practice Address - Phone:337-948-3162
Practice Address - Fax:337-948-3164
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA7875225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant