Provider Demographics
NPI:1184252405
Name:MCCARTHY, ELAINE FRANCES (PT)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:FRANCES
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36609 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-9429
Mailing Address - Country:US
Mailing Address - Phone:262-510-2165
Mailing Address - Fax:
Practice Address - Street 1:1185 CORPORATE CENTER DR STE 250
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4888
Practice Address - Country:US
Practice Address - Phone:262-569-6306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4226-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist