MEDICARE: MR. THOMAS JOHN MCCOIN P.T.

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	225100000X	Physical Therapist	PT 21316	CA
2	225100000X	Physical Therapist	21316	CA

General Provider Information

NPI Number	:	1578514063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS JOHN MCCOIN P.T.

Provider Business Mailing Address
First Line	:	5600 PONY EXPRESS TRAIL
Second Line	:	#A
City	:	CAMINO
State	:	CA
Zip	:	95709
Country	:	US
Telephone Number	:	530-644-5225
Fax Number	:	530-644-5777

Provider Business Practice Location Address
First Line	:	5600 PONY EXPRESS TRAIL
Second Line	:	#A
City	:	CAMINO
State	:	CA
Zip	:	95709
Country	:	US
Telephone Number	:	530-644-5225
Fax Number	:	530-644-5777

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	03/16/2011

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