Healthcare Provider Details

I. General information

NPI: 1326045121
Provider Name (Legal Business Name): MARK W MCCOY P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W MAIN ST
COVINGTON VA
24426-1517
US

IV. Provider business mailing address

PO BOX 136
COVINGTON VA
24426-0136
US

V. Phone/Fax

Practice location:
  • Phone: 540-962-6226
  • Fax: 540-962-7447
Mailing address:
  • Phone: 540-962-6226
  • Fax: 540-962-7447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305202368
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: