Provider Demographics
NPI:1578876629
Name:MCCARTHY, DIANDRA MICHELLE
Entity Type:Individual
Prefix:
First Name:DIANDRA
Middle Name:MICHELLE
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANDRA
Other - Middle Name:MICHELLE
Other - Last Name:LONGHURST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 866308
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75086-6308
Mailing Address - Country:US
Mailing Address - Phone:800-793-5464
Mailing Address - Fax:267-321-2099
Practice Address - Street 1:1 ORTHOPEDICS DR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1668
Practice Address - Country:US
Practice Address - Phone:978-854-4838
Practice Address - Fax:978-854-4839
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19125225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist