Provider Demographics
NPI:1679361257
Name:MCCARDLE, CARL WAYNE II (LMT)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:WAYNE
Last Name:MCCARDLE
Suffix:II
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13014 DOGWOOD BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3320
Mailing Address - Country:US
Mailing Address - Phone:281-746-8422
Mailing Address - Fax:
Practice Address - Street 1:13014 DOGWOOD BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3320
Practice Address - Country:US
Practice Address - Phone:281-746-8422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT145133225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist