=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124237706
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBIN MARIE MCCARTNEY P.T.A.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 CAPEWOOD RD APT 261
-----------------------------------------------------
City | SIMPSONVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29680-2776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-303-9869
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 CAPEWOOD RD APT 261
-----------------------------------------------------
City | SIMPSONVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29680-2776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-303-9869
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 2029
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------