Healthcare Provider Details

I. General information

NPI: 1104031855
Provider Name (Legal Business Name): SALLY J MCCOY LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 MERRIMON AVE
ASHEVILLE NC
28801-1815
US

IV. Provider business mailing address

5434 STATE HIGHWAY 197 S
BURNSVILLE NC
28714-7621
US

V. Phone/Fax

Practice location:
  • Phone: 828-254-8889
  • Fax: 828-254-8887
Mailing address:
  • Phone: 828-682-6979
  • Fax: 828-254-8887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1343
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: