Provider Demographics
NPI:1396026092
Name:MCCARTHA, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MCCARTHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 HAWTHORN ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-1807
Mailing Address - Country:US
Mailing Address - Phone:205-637-7120
Mailing Address - Fax:
Practice Address - Street 1:3605 RATLIFF RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35210-4512
Practice Address - Country:US
Practice Address - Phone:205-956-2184
Practice Address - Fax:205-956-2195
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3867225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist