Provider Demographics
NPI:1194972638
Name:MCCARTY, STANLEY MERLE (PTA)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:MERLE
Last Name:MCCARTY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 MARGARET AVE
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-3339
Mailing Address - Country:US
Mailing Address - Phone:812-222-2223
Mailing Address - Fax:
Practice Address - Street 1:2222 MARGARET AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-3339
Practice Address - Country:US
Practice Address - Phone:812-222-2223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003098A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant