Provider Demographics
NPI:1750491528
Name:MCKEE, ARCHIBALD STURDIVANT JR (MPT)
Entity Type:Individual
Prefix:MR
First Name:ARCHIBALD
Middle Name:STURDIVANT
Last Name:MCKEE
Suffix:JR
Gender:M
Credentials:MPT
Other - Prefix:MR
Other - First Name:STURDY
Other - Middle Name:
Other - Last Name:MCKEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPT
Mailing Address - Street 1:3727 BUCHANAN STREET
Mailing Address - Street 2:STE 205
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123
Mailing Address - Country:US
Mailing Address - Phone:415-593-2532
Mailing Address - Fax:415-593-7974
Practice Address - Street 1:3727 BUCHANAN STREET
Practice Address - Street 2:STE 205
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123
Practice Address - Country:US
Practice Address - Phone:415-593-2532
Practice Address - Fax:415-593-7974
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPT221420Medicare ID - Type Unspecified
S95648Medicare UPIN