MEDICARE: JACOB MCCARTHY PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1315215	TX

General Provider Information

NPI Number	:	1730646795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB MCCARTHY PT, DPT

Provider Business Mailing Address
First Line	:	5849 STONEHAVEN DR
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76502-4418
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	757 E US HIGHWAY 80
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-8735
Country	:	US
Telephone Number	:	903-343-3630
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2019
Last Update Date	:	02/26/2019

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