Provider Demographics
NPI:1669881199
Name:MCCARTY, JENNA WADSWORTH
Entity type:Individual
Prefix:MS
First Name:JENNA
Middle Name:WADSWORTH
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:W
Other - Last Name:MCCARTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2072 ORCHARD DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-0784
Mailing Address - Country:US
Mailing Address - Phone:949-701-5709
Mailing Address - Fax:
Practice Address - Street 1:2072 ORCHARD DR
Practice Address - Street 2:SUITE C
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0784
Practice Address - Country:US
Practice Address - Phone:949-701-5709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No174H00000XOther Service ProvidersHealth Educator
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist