Provider Demographics
NPI:1396378477
Name:MCCOY, CHANDRA A (ATC)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:A
Last Name:MCCOY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-5279
Mailing Address - Country:US
Mailing Address - Phone:304-372-7350
Mailing Address - Fax:
Practice Address - Street 1:1 PLAZA DR
Practice Address - Street 2:
Practice Address - City:RAVENSWOOD
Practice Address - State:WV
Practice Address - Zip Code:26164-1718
Practice Address - Country:US
Practice Address - Phone:304-273-9301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0699028412081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
069902841OtherNATABOC