Healthcare Provider Details

I. General information

NPI: 1477518553
Provider Name (Legal Business Name): SEAN MICHAEL MCQUEENEY MPT, ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15707 N 83RD AVE
PEORIA AZ
85382-3827
US

IV. Provider business mailing address

11950 W FLORES DR
EL MIRAGE AZ
85335-4304
US

V. Phone/Fax

Practice location:
  • Phone: 623-776-4854
  • Fax: 623-776-4826
Mailing address:
  • Phone: 623-466-8348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number6629
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0550
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: