Provider Demographics
NPI:1831413145
Name:MCCARTHY, AMANDA KRISTEN (MSPT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:KRISTEN
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1543 N BOWLING GREEN DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3627
Mailing Address - Country:US
Mailing Address - Phone:856-795-0908
Mailing Address - Fax:
Practice Address - Street 1:1543 N BOWLING GREEN DR
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-3627
Practice Address - Country:US
Practice Address - Phone:856-795-0908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01283700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist