Healthcare Provider Details

I. General information

NPI: 1629136759
Provider Name (Legal Business Name): HIGHLANDS THERAPY & INDUSTRIAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 11/12/2010
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
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number119002847
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119004057
License Number StateVA

VIII. Authorized Official

Name: MR. MARK WILLIAM MCCOY
Title or Position: PRESIDENT
Credential: PHYSICAL THERAPIST
Phone: 540-962-6226