Provider Demographics
NPI:1407908296
Name:MCCARTY, TRACY LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYNN
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 1:5661 PERRY LN
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66203-2446
Mailing Address - Country:US
Mailing Address - Phone:913-963-9153
Mailing Address - Fax:
Practice Address - Street 1:11900 W 87TH STREET PKWY
Practice Address - Street 2:SUITE 125
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-2807
Practice Address - Country:US
Practice Address - Phone:913-747-6100
Practice Address - Fax:913-747-6101
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01272225100000X
MOR1184225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist