Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 6629 | AZ |
NPI | 1477518553 |
---|---|
Provider Name | Sean Michael Mcqueeney |
First Address | El Mirage, AZ 85335-4304 |
Second Address | Peoria, AZ 85382-3827 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 22/01/2014 |