Provider Demographics
NPI:1962800896
Name:MCCAY, BRENT ANTHONY (LPTA)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:ANTHONY
Last Name:MCCAY
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 FIGUEROH AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-1845
Mailing Address - Country:US
Mailing Address - Phone:505-701-5188
Mailing Address - Fax:
Practice Address - Street 1:2825 FIGUEROH AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-1845
Practice Address - Country:US
Practice Address - Phone:505-701-5188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-1086225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant