Provider Demographics
NPI:1275852675
Name:MCCOY, NORLEEN R (P T)
Entity Type:Individual
Prefix:MS
First Name:NORLEEN
Middle Name:R
Last Name:MCCOY
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 N BOUNDARY AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-3173
Mailing Address - Country:US
Mailing Address - Phone:386-738-3456
Mailing Address - Fax:386-738-3466
Practice Address - Street 1:890 N BOUNDARY AVE
Practice Address - Street 2:STE 200
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3173
Practice Address - Country:US
Practice Address - Phone:386-738-3456
Practice Address - Fax:386-738-3466
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT11570225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist