1700284957 NPI number — MICHELLE MCCARTHY PHYSICAL THERAPY, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700284957 NPI number — MICHELLE MCCARTHY PHYSICAL THERAPY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHELLE MCCARTHY PHYSICAL THERAPY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MCCARTHY PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700284957
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8726 S. SEPULVEDA BLVD
Provider Second Line Business Mailing Address:
SUITE D-271
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
424-781-3388
Provider Business Mailing Address Fax Number:
888-798-0831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11835 W. OLYMPIC BLVD
Provider Second Line Business Practice Location Address:
SUITE 135E
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-781-3388
Provider Business Practice Location Address Fax Number:
888-798-0831
Provider Enumeration Date:
12/19/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MCCARTHY
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
424-781-3388

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  23396 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1548283443 . This is a "MEDICARE NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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