Healthcare Provider Details

I. General information

NPI: 1730795105
Provider Name (Legal Business Name): GENE EWING MCKEVIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 CASSATA CT
WEST BABYLON NY
11704-6932
US

IV. Provider business mailing address

142 CASSATA CT
WEST BABYLON NY
11704-6932
US

V. Phone/Fax

Practice location:
  • Phone: 703-599-8817
  • Fax:
Mailing address:
  • Phone: 703-599-8817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA62383
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number033280-01
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019006223
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT0953
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: