Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | P1 60657590 | WA |
NPI | 1003350315 |
---|---|
Provider Name | Emily Mccoy |
First Address | Milwaukie, OR 97222-4628 |
Second Address | Milwaukie, OR 97222-4628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2016 |
Last Update Date | 06/12/2016 |