MEDICARE: HIGHLANDS THERAPY & INDUSTRIAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	119002847	VA
2	225X00000X	Occupational Therapist	0119004057	VA
3	225100000X	Physical Therapist	2305202368	VA

General Provider Information

NPI Number	:	1629136759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGHLANDS THERAPY & INDUSTRIAL

Provider Business Mailing Address
First Line	:	PO BOX 136
Second Line	:
City	:	COVINGTON
State	:	VA
Zip	:	24426-0136
Country	:	US
Telephone Number	:	540-962-6226
Fax Number	:	540-962-7447

Provider Business Practice Location Address
First Line	:	320 W MAIN ST
Second Line	:
City	:	COVINGTON
State	:	VA
Zip	:	24426-1517
Country	:	US
Telephone Number	:	540-962-6226
Fax Number	:	540-962-7447

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MARK WILLIAM MCCOY
Credential	:	PHYSICAL THERAPIST
Telephone Number	:	540-962-6226

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	11/12/2010

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Directions to “HIGHLANDS THERAPY & INDUSTRIAL ” Practice Location

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