Basic Information
| Provider Information | |||||||||
| NPI: | 1255978268 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCARTHY | ||||||||
| FirstName: | SUMMER | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200A PINE ST | ||||||||
| Address2: | |||||||||
| City: | KILGORE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756623356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9039850685 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2131 ALPINE RD | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756013402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037578786 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2019 | ||||||||
| LastUpdateDate: | 12/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2151341 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.