Individual
RAVEN MCCOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2475 LAKELAND DR STE A, JACKSON, MS 39232-9505
(601) 664-1022
(601) 664-1076
Mailing address
1054 HIGHLAND COVE PL, RIDGELAND, MS 39157-1523
(601) 636-6019
(601) 661-8457
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT3962
MS
Other
Enumeration date
03/29/2007
Last updated
07/08/2007
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