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NPI Code Detail

MEDICARE: GLORIA MCCOY LMT

MEDICARE:   GLORIA  MCCOY  LMT
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
1225700000XMassage Therapist6757NV

General Provider Information

NPI Number : 1609301589
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLORIA MCCOY LMT
Provider Business Mailing Address
First Line : 3705 SCUBA CIR UNIT 3
Second Line :
City : LAS VEGAS
State : NV
Zip : 89108-5160
Country : US
Telephone Number : 702-292-8123
Fax Number :
Provider Business Practice Location Address
First Line : 3705 SCUBA CIR UNIT 3
Second Line :
City : LAS VEGAS
State : NV
Zip : 89108-5160
Country : US
Telephone Number : 702-292-8123
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2017
Last Update Date : 04/27/2017

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Directions to “ GLORIA MCCOY LMT” Practice Location

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