Healthcare Provider Details

I. General information

NPI: 1982659686
Provider Name (Legal Business Name): STEPHEN M MCCARTHY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MAIN ST SUITE #222
WASHOUGAL WA
98671
US

IV. Provider business mailing address

1700 MAIN ST. SUITE #222
WASHOUGAL WA
98671
US

V. Phone/Fax

Practice location:
  • Phone: 360-835-5349
  • Fax: 360-835-5390
Mailing address:
  • Phone: 360-835-5349
  • Fax: 360-835-5390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5176
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9023
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: