Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2306605432 | VA |
NPI | 1003401167 |
---|---|
Provider Name | Lisa Mccoy |
First Address | Williamsburg, VA 23185-5648 |
Second Address | Williamsburg, VA 23185-5648 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2021 |
Last Update Date | 01/03/2021 |