Healthcare Provider Details

I. General information

NPI: 1821448200
Provider Name (Legal Business Name): MATTHEW MCCARTY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 S LOCUST ST
GRAND ISLAND NE
68801-6751
US

IV. Provider business mailing address

4829 CAROLINA BEACH RD STE 100
WILMINGTON NC
28412-2366
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-9700
  • Fax: 308-382-9898
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP16326
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3578
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: