Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1072569 | TX |
N | 2251P0200X | Physical Therapist - Pediatrics | 1072569 | TX |
NPI | 1003967183 |
---|---|
Provider Name | Marcia G Mckay |
First Address | Fort Worth, TX 76107-7277 |
Second Address | Fort Worth, TX 76107-7277 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 30/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
150401101 | (05) | TX |
8T2210 | BCBS (01) | TX |