Provider Demographics
NPI:1588895098
Name:MCCOY, CORTNEY DANYEL (PTA)
Entity type:Individual
Prefix:MISS
First Name:CORTNEY
Middle Name:DANYEL
Last Name:MCCOY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GENESIS HEALTHCARE ROUTE 92 PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986
Mailing Address - Country:US
Mailing Address - Phone:304-536-4661
Mailing Address - Fax:304-536-1328
Practice Address - Street 1:GENESIS HEALTHCARE ROUTE 92 AT ROUTE 60
Practice Address - Street 2:
Practice Address - City:WHITE SULPHUR SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:24986
Practice Address - Country:US
Practice Address - Phone:304-536-4661
Practice Address - Fax:304-536-1328
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001466225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant