Provider Demographics
NPI:1316928765
Name:MCQUIVEY, MICHAEL KENT (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KENT
Last Name:MCQUIVEY
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 1:18612 NW 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-9616
Mailing Address - Country:US
Mailing Address - Phone:360-576-8831
Mailing Address - Fax:
Practice Address - Street 1:9430 NE VANCOUVER MALL DR
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6172
Practice Address - Country:US
Practice Address - Phone:360-256-9827
Practice Address - Fax:360-256-9547
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist