Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT4540 | ME |
NPI | 1003273806 |
---|---|
Provider Name | Dana Mccoy |
First Address | Lewiston, ME 04240-7027 |
Second Address | Lewiston, ME 04240-7027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2016 |
Last Update Date | 25/01/2016 |