Provider Demographics
NPI:1639958143
Name:MCCOY, MERAIAH S (DPT)
Entity Type:Individual
Prefix:
First Name:MERAIAH
Middle Name:S
Last Name:MCCOY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-3654
Mailing Address - Country:US
Mailing Address - Phone:407-880-8438
Mailing Address - Fax:407-880-9570
Practice Address - Street 1:541 N PARK AVE
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-3654
Practice Address - Country:US
Practice Address - Phone:407-880-8438
Practice Address - Fax:407-880-9570
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40206225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist