Provider Demographics
NPI:1689679136
Name:MCAREAVEY, TODD DONOVAN (RPT)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:DONOVAN
Last Name:MCAREAVEY
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BLACKWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74631-3825
Mailing Address - Country:US
Mailing Address - Phone:580-363-1111
Mailing Address - Fax:580-363-1116
Practice Address - Street 1:904 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4301
Practice Address - Country:US
Practice Address - Phone:405-743-0101
Practice Address - Fax:580-363-1116
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT 2012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist