Provider Demographics
NPI:1629073788
Name:MCCARTHY PHYSICAL THERAPY AND SPORTS CENTER, INC.
Entity Type:Organization
Organization Name:MCCARTHY PHYSICAL THERAPY AND SPORTS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:916-789-1384
Mailing Address - Street 1:114 N SUNRISE AVE
Mailing Address - Street 2:STE B1
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2916
Mailing Address - Country:US
Mailing Address - Phone:916-789-1384
Mailing Address - Fax:916-782-7113
Practice Address - Street 1:114 N SUNRISE AVE
Practice Address - Street 2:STE B1
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2916
Practice Address - Country:US
Practice Address - Phone:916-789-1384
Practice Address - Fax:916-782-7113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ276832Medicare ID - Type Unspecified