Provider Demographics
NPI:1750681946
Name:MCCOY, GAILLENA (PT)
Entity Type:Individual
Prefix:MS
First Name:GAILLENA
Middle Name:
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 1:670 PARKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-1506
Mailing Address - Country:US
Mailing Address - Phone:718-675-1249
Mailing Address - Fax:718-675-1264
Practice Address - Street 1:670 PARKSIDE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-1506
Practice Address - Country:US
Practice Address - Phone:718-675-1249
Practice Address - Fax:718-675-1264
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004702012251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics