Provider Demographics
NPI:1437673852
Name:MCCOY, JILL (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 W LAKE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48763-5101
Mailing Address - Country:US
Mailing Address - Phone:989-984-6075
Mailing Address - Fax:
Practice Address - Street 1:540 W LAKE ST STE 3
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-5101
Practice Address - Country:US
Practice Address - Phone:989-984-6075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT4332225100000X
MI5501302185225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist