Provider Demographics
NPI:1962814004
Name:MCCARTHY, TRICIA (PTA)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:3191 MISSION INN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-4188
Mailing Address - Country:US
Mailing Address - Phone:951-684-2874
Mailing Address - Fax:
Practice Address - Street 1:14682 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-9505
Practice Address - Country:US
Practice Address - Phone:909-829-5439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10074225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant