Provider Demographics
NPI:1689806515
Name:MCCARTHY ORTHOPEDIC REHABILITATION AND SPORTS CLINIC INC
Entity Type:Organization
Organization Name:MCCARTHY ORTHOPEDIC REHABILITATION AND SPORTS CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:808-262-8808
Mailing Address - Street 1:415 ULUNIU ST
Mailing Address - Street 2:STE A
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2503
Mailing Address - Country:US
Mailing Address - Phone:808-262-8808
Mailing Address - Fax:808-263-5633
Practice Address - Street 1:820 MILILANI ST
Practice Address - Street 2:STE 702A
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2993
Practice Address - Country:US
Practice Address - Phone:808-523-9363
Practice Address - Fax:808-523-9418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT 1843225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty