Basic Information
| Provider Information | |||||||||
| NPI: | 1194701656 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCOY | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 S HOLMEN DR | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | HOLMEN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546369467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6085269888 | ||||||||
| FaxNumber: | 6085269965 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 S HOLMEN DR | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | HOLMEN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546369467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6085269888 | ||||||||
| FaxNumber: | 6085269965 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5029 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.