Provider Demographics
NPI:1922042670
Name:MCCARTY, KELLEY MASSEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:MASSEY
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:MASSEY
Other - Last Name:ZAJAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:199 N BROOKMOORE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2024
Mailing Address - Country:US
Mailing Address - Phone:662-327-6705
Mailing Address - Fax:662-327-6760
Practice Address - Street 1:104 CHELSEA POINT DR
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:AL
Practice Address - Zip Code:35043-4100
Practice Address - Country:US
Practice Address - Phone:205-453-9400
Practice Address - Fax:205-453-9410
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4111225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51533285OtherBCBS
AL51533273OtherBCBS
AL51533271OtherBCBS
AL51532732OtherBCBS
AL51533279OtherBCBS
AL51533281OtherBCBS
AL51533272OtherBCBS
AL51533282OtherBCBS
AL51533283OtherBCBS
AL51533283OtherBCBS
AL102I656513Medicare Oscar/Certification