Provider Demographics
NPI:1487004115
Name:MCCARTY, BLAIR (DPT)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BLAIR
Other - Middle Name:
Other - Last Name:LOSAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5550 PEDEN POINT RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-4308
Mailing Address - Country:US
Mailing Address - Phone:410-707-2984
Mailing Address - Fax:
Practice Address - Street 1:83 PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-9673
Practice Address - Country:US
Practice Address - Phone:410-707-2984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3579225100000X
NCP16343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist