Individual
MICAH MCCOLLOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
815 S WALNUT AVE, COOKEVILLE, TN 38501-5956
(931) 528-5516
Mailing address
2539 SPARKMANTOWN RD, DOYLE, TN 38559-3235
(931) 607-4885
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
7124
TN
Other
Enumeration date
08/07/2019
Last updated
08/07/2019
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