Provider Demographics
NPI:1548699176
Name:MCCARTHY, LEANNE (LMT)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 S WICKHAM RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-1436
Mailing Address - Country:US
Mailing Address - Phone:321-723-1011
Mailing Address - Fax:
Practice Address - Street 1:635 S WICKHAM RD
Practice Address - Street 2:SUITE 203
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-1436
Practice Address - Country:US
Practice Address - Phone:321-723-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA72934174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist