MEDICARE: MRS. WENDELIN JEAN MCCOY PT

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 006246-L	PA
2	2251H1200X	Hand Physical Therapist	PT 006246-L	PA

General Provider Information

NPI Number	:	1740677616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WENDELIN JEAN MCCOY PT

Provider Business Mailing Address
First Line	:	8529 LYONS PL
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19153-1911
Country	:	US
Telephone Number	:	215-492-9663
Fax Number	:

Provider Business Practice Location Address
First Line	:	8529 LYONS PL
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19153-1911
Country	:	US
Telephone Number	:	215-492-9663
Fax Number	:

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

Provider Enumeration Date	:	04/18/2015
Last Update Date	:	04/18/2015

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