Provider Demographics
NPI:1780610741
Name:MCGILVREY, JOSEPH JOHN (PT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JOHN
Last Name:MCGILVREY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15751 SAN CARLOS BLVD.
Mailing Address - Street 2:SUITE #4
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908
Mailing Address - Country:US
Mailing Address - Phone:239-337-2739
Mailing Address - Fax:239-337-2738
Practice Address - Street 1:15751 SAN CARLOS BLVD
Practice Address - Street 2:SUITE #4
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3314
Practice Address - Country:US
Practice Address - Phone:239-337-2739
Practice Address - Fax:239-337-2738
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21660225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6206ZMedicare ID - Type Unspecified