Individual
MACK MCCOY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2 WHARTON CT, IRVINE, CA 92617-4108
(949) 371-6225
Mailing address
2 WHARTON CT, IRVINE, CA 92617-4108
(949) 371-6225
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
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