Provider Demographics
NPI:1477299832
Name:MCCAMERON, CARLY (DPT)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:MCCAMERON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 GIUNTOLI LN
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-4495
Mailing Address - Country:US
Mailing Address - Phone:707-825-8100
Mailing Address - Fax:
Practice Address - Street 1:1551 GIUNTOLI LN
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4495
Practice Address - Country:US
Practice Address - Phone:707-825-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL302033225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist