Provider Demographics
NPI:1154344687
Name:MCGAHARN, MICHAEL ANTHONY II (MPT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:MCGAHARN
Suffix:II
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3695 DENAIR ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-1302
Mailing Address - Country:US
Mailing Address - Phone:626-351-0717
Mailing Address - Fax:626-351-0717
Practice Address - Street 1:3695 DENAIR ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-1302
Practice Address - Country:US
Practice Address - Phone:626-351-0717
Practice Address - Fax:626-351-0717
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 16319171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor