Provider Demographics
NPI:1013071133
Name:MCKOY, STACEY (MPT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:MCKOY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E 33RD ST STE 105
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-6795
Mailing Address - Country:US
Mailing Address - Phone:410-366-0791
Mailing Address - Fax:
Practice Address - Street 1:1100 E 33RD ST STE 105
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-6795
Practice Address - Country:US
Practice Address - Phone:410-366-0791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist