Provider Demographics
NPI:1740404060
Name:MCCARTHY, MICHAEL (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 ULUNIU ST # A
Mailing Address - Street 2:
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 1:415 ULUNIU ST #A
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2503
Practice Address - Country:US
Practice Address - Phone:808-262-8808
Practice Address - Fax:808-263-5633
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI958225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA9572-7OtherHMSA
HIHOOOOCBBMDMedicare UPIN