Provider Demographics
NPI:1801037148
Name:MCCOY, MICHELE M (PT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:M
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:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:FORT JONES
Mailing Address - State:CA
Mailing Address - Zip Code:96032-0217
Mailing Address - Country:US
Mailing Address - Phone:530-468-5528
Mailing Address - Fax:
Practice Address - Street 1:122 SCOTT RIVER ROAD
Practice Address - Street 2:
Practice Address - City:FORT JONES
Practice Address - State:CA
Practice Address - Zip Code:96032
Practice Address - Country:US
Practice Address - Phone:530-468-5528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABO100ZOtherMEDICARE PTAN