Provider Demographics
NPI:1245392976
Name:MCCARTHY, MICHELE (PT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:MCCARTHY
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 1:201 PLUMTREE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6044
Mailing Address - Country:US
Mailing Address - Phone:410-569-8587
Mailing Address - Fax:410-569-3551
Practice Address - Street 1:1401 PULASKI HWY STE F
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-1398
Practice Address - Country:US
Practice Address - Phone:443-372-5300
Practice Address - Fax:443-372-5810
Is Sole Proprietor?:No
Enumeration Date:2006-12-16
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD803251Y76Medicare PIN