Provider Demographics
NPI:1255978268
Name:MCCARTHY, SUMMER ANNE (PTA)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:ANNE
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200A PINE ST
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-3356
Mailing Address - Country:US
Mailing Address - Phone:903-985-0685
Mailing Address - Fax:
Practice Address - Street 1:2131 ALPINE RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-3402
Practice Address - Country:US
Practice Address - Phone:903-757-8786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2151341225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant