Provider Demographics
NPI:1891994695
Name:MCCARTHY, LINDA DIANE (PT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:DIANE
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:DIANE
Other - Last Name:FROMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4329 GREEN LEAF DR
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-8966
Mailing Address - Country:US
Mailing Address - Phone:608-935-0687
Mailing Address - Fax:
Practice Address - Street 1:208 NORTH WINSTED ST.
Practice Address - Street 2:
Practice Address - City:SPRING GREEN
Practice Address - State:WI
Practice Address - Zip Code:53588
Practice Address - Country:US
Practice Address - Phone:608-341-9881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4129-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist