Provider Demographics
NPI:1023376563
Name:MCCARTHY ORTHOPEDIC REHABILITATION & SPORTS MEDICINE, INC.
Entity type:Organization
Organization Name:MCCARTHY ORTHOPEDIC REHABILITATION & SPORTS MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:808-262-8808
Mailing Address - Street 1:415 ULUNIU ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2503
Mailing Address - Country:US
Mailing Address - Phone:808-262-8808
Mailing Address - Fax:808-263-5633
Practice Address - Street 1:415 ULUNIU ST
Practice Address - Street 2:SUITE A
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2503
Practice Address - Country:US
Practice Address - Phone:808-262-8808
Practice Address - Fax:808-263-5633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPHYSICAL THERAPY 958261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy