Healthcare Provider Details

I. General information

NPI: 1891000139
Provider Name (Legal Business Name): LOREE MCCARY ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1936 NORTH ST SFA SPORTS MEDICINE CLINIC
NACOGDOCHES TX
75965-3940
US

IV. Provider business mailing address

PO BOX 13010 SFA STATION
NACOGDOCHES TX
75962-0001
US

V. Phone/Fax

Practice location:
  • Phone: 936-468-4550
  • Fax: 936-468-4052
Mailing address:
  • Phone: 936-468-4550
  • Fax: 936-468-4052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberAT1184
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: