Healthcare Provider Details

I. General information

NPI: 1194926618
Provider Name (Legal Business Name): MARCIA K. MCCOY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 AVALON RD
MOUNT VERNON OH
43050-1403
US

IV. Provider business mailing address

16169 OLD MANSFIELD RD
FREDERICKTOWN OH
43019-9604
US

V. Phone/Fax

Practice location:
  • Phone: 740-397-3200
  • Fax:
Mailing address:
  • Phone: 740-397-4664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number04224
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: