Provider Demographics
NPI:1831679000
Name:MCCORMICK, DARCY JO (PTA, CPT)
Entity Type:Individual
Prefix:MRS
First Name:DARCY
Middle Name:JO
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:PTA, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N27W30097 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-4252
Mailing Address - Country:US
Mailing Address - Phone:262-751-6503
Mailing Address - Fax:
Practice Address - Street 1:W314 N720 STATE HWY 83
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018
Practice Address - Country:US
Practice Address - Phone:262-361-2056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2005-15225200000X
WI2005-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant