Provider Demographics
NPI:1497848956
Name:MCCARTHY, MICHELE KATHRYN (PT, MSPT, OCS, CHT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:KATHRYN
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:PT, MSPT, OCS, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 N NASH ST
Mailing Address - Street 2:STE # 306
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2825
Mailing Address - Country:US
Mailing Address - Phone:310-535-0008
Mailing Address - Fax:310-535-0009
Practice Address - Street 1:615 N NASH ST
Practice Address - Street 2:STE # 306
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-2825
Practice Address - Country:US
Practice Address - Phone:310-535-0008
Practice Address - Fax:310-535-0009
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 30266225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist