Provider Demographics
NPI:1780960948
Name:MCGAVER, MARY E (MPT, MS, PT, ATC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:MCGAVER
Suffix:
Gender:F
Credentials:MPT, MS, PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2201 LAKE SHORE DRIVE EAST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-2331
Mailing Address - Country:US
Mailing Address - Phone:715-685-6600
Mailing Address - Fax:715-685-6601
Practice Address - Street 1:2201 LAKE SHORE DRIVE EAST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-2331
Practice Address - Country:US
Practice Address - Phone:715-685-6600
Practice Address - Fax:715-685-6601
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017438225100000X
MN7067225100000X
WI969-392255A2300X
MN20852255A2300X
WI9955-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer