Provider Demographics
NPI:1750737185
Name:MCCORMICK, TYME (PTA)
Entity type:Individual
Prefix:
First Name:TYME
Middle Name:
Last Name:MCCORMICK
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 1:4500 W NEWBERRY RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2245
Mailing Address - Country:US
Mailing Address - Phone:352-336-6000
Mailing Address - Fax:352-336-6029
Practice Address - Street 1:201 W GUAVA ST
Practice Address - Street 2:SUITES 204 & 205
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-1701
Practice Address - Country:US
Practice Address - Phone:352-633-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA26272225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant