Healthcare Provider Details

I. General information

NPI: 1922509785
Provider Name (Legal Business Name): CATHY LYNN MCCOY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WESTWOOD ST
GLASGOW KY
42141-1030
US

IV. Provider business mailing address

125 RAYMOND BROWN RD
EDMONTON KY
42129-7000
US

V. Phone/Fax

Practice location:
  • Phone: 270-651-9131
  • Fax:
Mailing address:
  • Phone: 270-432-3574
  • Fax: 270-432-3574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA03214
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: