Provider Demographics
NPI:1013508837
Name:MCCOY, JULIA (LMT#25007)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LMT#25007
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7171 CROWFOOT RD
Mailing Address - Street 2:
Mailing Address - City:TRAIL
Mailing Address - State:OR
Mailing Address - Zip Code:97541-9624
Mailing Address - Country:US
Mailing Address - Phone:541-941-6687
Mailing Address - Fax:
Practice Address - Street 1:33 N CENTRAL AVE STE 401
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-5923
Practice Address - Country:US
Practice Address - Phone:541-941-6687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25007225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist