Provider Demographics
NPI:1780031120
Name:MCVAY, IAN (PTA)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:MCVAY
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 1:6244 SW 208TH TER
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97078-8695
Mailing Address - Country:US
Mailing Address - Phone:760-641-1721
Mailing Address - Fax:
Practice Address - Street 1:7412 SW BEAVERTON HILLSDALE HWY STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-2167
Practice Address - Country:US
Practice Address - Phone:503-616-0313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9925225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant