Provider Demographics
NPI:1376649921
Name:MCCARTHY, GARY WAYNE (PT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:WAYNE
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21719 CHANDELLE CIR
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-5583
Mailing Address - Country:US
Mailing Address - Phone:907-688-4590
Mailing Address - Fax:907-688-4591
Practice Address - Street 1:21719 CHANDELLE CIR
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567-5583
Practice Address - Country:US
Practice Address - Phone:907-688-4590
Practice Address - Fax:907-688-4591
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK0722251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic