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General NPI Number Information
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NPI Number | 1043575301
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Entity Type | Individual
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Provider Name | JERRY WALTER COY L.M.T.
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Gender | Male
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 07/11/2012
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Provider Practice Location Address
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Address Line | 44400 W HONEYCUTT RD STE 101
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City | MARICOPA
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State | AZ
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Zip | 85138-2944
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Country | US
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Telephone | 602-770-0263
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Fax |
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Provider Business Mailing Address
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Address Line | 44640 W YUCCA LN
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City | MARICOPA
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State | AZ
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Zip | 85138-4036
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Country | US
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Telephone | 602-770-0263
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173C00000X
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Taxonomy Name | Reflexologist
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License Number | MT-05220
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT-05220
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License Number State | AZ
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