Provider Demographics
NPI:1629136759
Name:HIGHLANDS THERAPY & INDUSTRIAL
Entity Type:Organization
Organization Name:HIGHLANDS THERAPY & INDUSTRIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:540-962-6226
Mailing Address - Street 1:PO BOX 136
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-0136
Mailing Address - Country:US
Mailing Address - Phone:540-962-6226
Mailing Address - Fax:540-962-7447
Practice Address - Street 1:320 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-1517
Practice Address - Country:US
Practice Address - Phone:540-962-6226
Practice Address - Fax:540-962-7447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202368225100000X
VA119002847225X00000X
VA0119004057225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACJ2494Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP N
VAC06382Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER