Provider Demographics
NPI:1871258780
Name:MCCARTER, BRODY (LMT)
Entity Type:Individual
Prefix:
First Name:BRODY
Middle Name:
Last Name:MCCARTER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 W CAMINO TUNERA
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-8271
Mailing Address - Country:US
Mailing Address - Phone:520-336-4120
Mailing Address - Fax:
Practice Address - Street 1:817 W CAMINO TUNERA
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-8271
Practice Address - Country:US
Practice Address - Phone:520-447-7227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-27135225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist