Provider Demographics
NPI:1801313473
Name:MCCONVILLE, JOHN (DPT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MCCONVILLE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6604 ROBERTA RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-9532
Mailing Address - Country:US
Mailing Address - Phone:704-455-1172
Mailing Address - Fax:
Practice Address - Street 1:6604 ROBERTA RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-9532
Practice Address - Country:US
Practice Address - Phone:704-455-1172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11813225100000X
NJ40QA01970000225100000X
NCP20047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist