Provider Demographics
NPI:1578514063
Name:MCCOIN, THOMAS JOHN (PT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JOHN
Last Name:MCCOIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5600 PONY EXPRESS TRAIL
Mailing Address - Street 2:#A
Mailing Address - City:CAMINO
Mailing Address - State:CA
Mailing Address - Zip Code:95709
Mailing Address - Country:US
Mailing Address - Phone:530-644-5225
Mailing Address - Fax:530-644-5777
Practice Address - Street 1:5600 PONY EXPRESS TRAIL
Practice Address - Street 2:#A
Practice Address - City:CAMINO
Practice Address - State:CA
Practice Address - Zip Code:95709
Practice Address - Country:US
Practice Address - Phone:530-644-5225
Practice Address - Fax:530-644-5777
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 21316225100000X
CA21316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist