Provider Demographics
NPI:1518219823
Name:MCCOY, JOSEPH R (LMT, MMP)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:R
Last Name:MCCOY
Suffix:
Gender:M
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 N SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:MUENSTER
Mailing Address - State:TX
Mailing Address - Zip Code:76252-2528
Mailing Address - Country:US
Mailing Address - Phone:940-641-0867
Mailing Address - Fax:
Practice Address - Street 1:218 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MUENSTER
Practice Address - State:TX
Practice Address - Zip Code:76252
Practice Address - Country:US
Practice Address - Phone:940-759-2505
Practice Address - Fax:940-759-2970
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT103804225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist