Provider Demographics
NPI:1801041355
Name:MCCARLEY, REXALL G (PT)
Entity Type:Individual
Prefix:
First Name:REXALL
Middle Name:G
Last Name:MCCARLEY
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 1:275 KESSLER STREET
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125
Mailing Address - Country:US
Mailing Address - Phone:614-439-6773
Mailing Address - Fax:
Practice Address - Street 1:1700 HEINZERLING DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43119
Practice Address - Country:US
Practice Address - Phone:614-274-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT#08595171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor