Healthcare Provider Details

I. General information

NPI: 1134207400
Provider Name (Legal Business Name): ERIN M MCCOY P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 17TH AVE E
ALEXANDRIA MN
56308-5273
US

IV. Provider business mailing address

4006 FOREST PARK RD SW
ALEXANDRIA MN
56308-9303
US

V. Phone/Fax

Practice location:
  • Phone: 320-762-6079
  • Fax:
Mailing address:
  • Phone: 320-759-2371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6235
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: