Healthcare Provider Details

I. General information

NPI: 1104537901
Provider Name (Legal Business Name): MICHAEL G MCCARTY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10133 SHERRILL BLVD STE 200
KNOXVILLE TN
37932-3347
US

IV. Provider business mailing address

2815 HOMEWAY DR
BEAVERCREEK OH
45434-5706
US

V. Phone/Fax

Practice location:
  • Phone: 865-531-2204
  • Fax:
Mailing address:
  • Phone: 937-607-1992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5086
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: