Provider Demographics
NPI:1508085978
Name:MCCOY, STEFANIE S (PT)
Entity Type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:S
Last Name:MCCOY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 PETERSON ST
Mailing Address - Street 2:
Mailing Address - City:HOLMEN
Mailing Address - State:WI
Mailing Address - Zip Code:54636-8805
Mailing Address - Country:US
Mailing Address - Phone:608-526-2690
Mailing Address - Fax:608-526-9955
Practice Address - Street 1:106 S HOLMEN DR
Practice Address - Street 2:SUITE 2
Practice Address - City:HOLMEN
Practice Address - State:WI
Practice Address - Zip Code:54636-9467
Practice Address - Country:US
Practice Address - Phone:608-526-9888
Practice Address - Fax:608-526-9965
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40267800Medicaid