MEDICARE: EMILY MCCOY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AT1639	OTHER	CO	LICENSE

General Provider Information

NPI Number	:	1144330739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY MCCOY

Provider Business Mailing Address
First Line	:	1440 EDORA RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1267
Country	:	US
Telephone Number	:	619-884-2534
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 S LEMAY AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3543
Country	:	US
Telephone Number	:	970-482-5242
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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Directions to “ EMILY MCCOY ” Practice Location

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