Provider Demographics
NPI:1811218597
Name:MCCARTHY, MARY SHANNON (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SHANNON
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 BAR HARBOR TER
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4401
Mailing Address - Country:US
Mailing Address - Phone:847-722-0457
Mailing Address - Fax:847-919-4405
Practice Address - Street 1:666 DUNDEE RD
Practice Address - Street 2:SUITE 1903
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2727
Practice Address - Country:US
Practice Address - Phone:847-722-0457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.0063242251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic