Provider Demographics
NPI:1215349782
Name:MCCARTHY, SUSAN (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 TILDEN RD
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-2124
Mailing Address - Country:US
Mailing Address - Phone:781-545-4338
Mailing Address - Fax:
Practice Address - Street 1:99 LONGWATER CIR
Practice Address - Street 2:SUITE 210 ASSINIPPI PARK
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1642
Practice Address - Country:US
Practice Address - Phone:781-347-4686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist