Provider Demographics
NPI:1609123371
Name:MCCARTHY, TRACI ALLISON (DPT)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:ALLISON
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:JESSOP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:226 MIDDLE RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1945
Mailing Address - Country:US
Mailing Address - Phone:732-888-9889
Mailing Address - Fax:
Practice Address - Street 1:226 MIDDLE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1945
Practice Address - Country:US
Practice Address - Phone:732-888-9889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01452300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist