Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT 006246-L | PA |
Y | 2251H1200X | Hand | PT 006246-L | PA |
NPI | 1740677616 |
---|---|
Provider Name | Mrs. Wendelin Jean Mccoy |
First Address | Philadelphia, PA 19153-1911 |
Second Address | Philadelphia, PA 19153-1911 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2015 |
Last Update Date | 18/04/2015 |