Provider Demographics
NPI:1326045121
Name:MCCOY, MARK W (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:W
Last Name:MCCOY
Suffix:
Gender:M
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:PO BOX 136
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-0136
Mailing Address - Country:US
Mailing Address - Phone:540-962-6226
Mailing Address - Fax:540-962-7447
Practice Address - Street 1:320 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-1517
Practice Address - Country:US
Practice Address - Phone:540-962-6226
Practice Address - Fax:540-962-7447
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202368225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA195325OtherANTHEM PROVIDER NUMBER
VA195325OtherANTHEM PROVIDER NUMBER