Provider Demographics
NPI:1609019454
Name:MCCARTY, AUDREY LYNN (DPT)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:LYNN
Last Name:MCCARTY
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 1:160 W MAGNOLIA AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7654
Mailing Address - Country:US
Mailing Address - Phone:817-335-7946
Mailing Address - Fax:817-335-7946
Practice Address - Street 1:160 W MAGNOLIA AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7654
Practice Address - Country:US
Practice Address - Phone:817-335-7946
Practice Address - Fax:817-335-7946
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8148225100000X
TX1213242225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist