Provider Demographics
NPI:1710335534
Name:MCLARTY, GREGORY A (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:A
Last Name:MCLARTY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3559 E TULSA ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-3456
Mailing Address - Country:US
Mailing Address - Phone:480-227-5639
Mailing Address - Fax:
Practice Address - Street 1:8283 N HAYDEN RD STE 125
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-2455
Practice Address - Country:US
Practice Address - Phone:480-474-4921
Practice Address - Fax:480-447-4983
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-012232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ164661Medicaid