Provider Demographics
NPI:1700284957
Name:MICHELLE MCCARTHY PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:MICHELLE MCCARTHY PHYSICAL THERAPY, INC
Other - Org Name:MCCARTHY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:424-781-3388
Mailing Address - Street 1:8726 S. SEPULVEDA BLVD
Mailing Address - Street 2:SUITE D-271
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045
Mailing Address - Country:US
Mailing Address - Phone:424-781-3388
Mailing Address - Fax:888-798-0831
Practice Address - Street 1:11835 W. OLYMPIC BLVD
Practice Address - Street 2:SUITE 135E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064
Practice Address - Country:US
Practice Address - Phone:424-781-3388
Practice Address - Fax:888-798-0831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23396261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1548283443OtherMEDICARE NPI