Provider Demographics
NPI:1023445129
Name:MCEWEN, GARY N II (PT)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:N
Last Name:MCEWEN
Suffix:II
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-928-5080
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:14601 N SCOTTSDALE RD STE 108
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2984
Practice Address - Country:US
Practice Address - Phone:480-729-8400
Practice Address - Fax:480-651-8102
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-1560225100000X
AZLPT-31177225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist