Provider Demographics
NPI:1548765548
Name:MCCARLEY, AMY WILSON (PT DPT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:WILSON
Last Name:MCCARLEY
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1362 JOPLIN DR
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-5516
Mailing Address - Country:US
Mailing Address - Phone:662-809-9119
Mailing Address - Fax:
Practice Address - Street 1:1966 F S HILL DR
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-5047
Practice Address - Country:US
Practice Address - Phone:662-226-2442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS6181225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist