Individual
MACK MCCOY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
74342
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1445509
AMTA MEMBERSHIP
—
01
—
74342
CAMTC CERTIFICATION
CA
Enumeration date
08/09/2021
Last updated
08/09/2021
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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