Provider Demographics
NPI:1154771426
Name:MCCOY, LANE (DPT)
Entity type:Individual
Prefix:
First Name:LANE
Middle Name:
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 1:1333 ISLAND TOWN DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-9027
Mailing Address - Country:US
Mailing Address - Phone:931-212-4656
Mailing Address - Fax:
Practice Address - Street 1:2996 KATE BOND RD STE 305
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-4063
Practice Address - Country:US
Practice Address - Phone:901-767-8662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10830225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist