Provider Demographics
NPI:1003934381
Name:MCCARTY, LORI JEAN (PT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:JEAN
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1409
Mailing Address - Country:US
Mailing Address - Phone:310-656-8600
Mailing Address - Fax:310-656-8606
Practice Address - Street 1:427 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1409
Practice Address - Country:US
Practice Address - Phone:310-656-8600
Practice Address - Fax:310-656-8606
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 35508225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADA887YMedicare PIN
CADA887XMedicare PIN