Provider Demographics
NPI:1225874712
Name:MCCOY, ANDREW T (DPT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:T
Last Name:MCCOY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10821 19TH AVE SE STE 102
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-5103
Mailing Address - Country:US
Mailing Address - Phone:425-225-5865
Mailing Address - Fax:509-808-2164
Practice Address - Street 1:10821 19TH AVE SE STE 102
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-5103
Practice Address - Country:US
Practice Address - Phone:425-225-5865
Practice Address - Fax:509-808-2164
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61578390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist