Provider Demographics
NPI:1184782450
Name:MCCORMICK, DOREEN LYNN (PT,)
Entity type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:LYNN
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:PT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9002 BRENTFIELD RD
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5821
Mailing Address - Country:US
Mailing Address - Phone:704-895-1912
Mailing Address - Fax:704-895-1912
Practice Address - Street 1:9002 BRENTFIELD RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5821
Practice Address - Country:US
Practice Address - Phone:704-895-1912
Practice Address - Fax:704-895-1912
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist