Provider Demographics
NPI:1972859205
Name:MCCARTY, KIRSTEN JANE (PTA)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:JANE
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 PROVIDENCE LANE NE
Mailing Address - Street 2:MS: 01B03
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506
Mailing Address - Country:US
Mailing Address - Phone:360-493-4995
Mailing Address - Fax:360-493-4470
Practice Address - Street 1:410 PROVIDENCE LANE NE
Practice Address - Street 2:MS: 01B03
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-493-4995
Practice Address - Fax:360-493-4470
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160100398225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant