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General NPI Number Information
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NPI Number | 1841532827
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Entity Type | Organization
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Legal Business Name | MCCARTHY SPINE AND SPORT PC
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Dates
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Enumeration Date | 03/18/2013
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Last Update Date | 03/18/2013
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Provider Practice Location Address
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Address Line | 666 DUNDEE RD 1903
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City | NORTHBROOK
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State | IL
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Zip | 60062-2727
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Country | US
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Telephone | 847-722-0457
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Fax | 847-919-4405
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Provider Business Mailing Address
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Address Line | 1241 BAR HARBOR TER
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City | NORTHBROOK
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State | IL
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Zip | 60062-4401
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Country | US
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Telephone | 847-722-0457
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Fax | 847-919-4405
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MS. MARY SHANNON MCCARTHY
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Credential | PHYSICAL THERAPIST
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Telephone | 847-722-0457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 070.006324
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License Number State | IL
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