Healthcare Provider Details

I. General information

NPI: 1811815640
Provider Name (Legal Business Name): AVIONE MCGHEE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 DALE RD
MODESTO CA
95356-9718
US

IV. Provider business mailing address

5656 WILLS CREEK LN
FORT WORTH TX
76179-7626
US

V. Phone/Fax

Practice location:
  • Phone: 209-735-5000
  • Fax:
Mailing address:
  • Phone: 214-493-9187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number310156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: