Healthcare Provider Details

I. General information

NPI: 1376649921
Provider Name (Legal Business Name): GARY WAYNE MCCARTHY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21719 CHANDELLE CIR
CHUGIAK AK
99567-5583
US

IV. Provider business mailing address

21719 CHANDELLE CIR
CHUGIAK AK
99567-5583
US

V. Phone/Fax

Practice location:
  • Phone: 907-688-4590
  • Fax: 907-688-4591
Mailing address:
  • Phone: 907-688-4590
  • Fax: 907-688-4591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number072
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: