Provider Demographics
NPI:1902327265
Name:MCCORMAC, NANCY C (PT)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:C
Last Name:MCCORMAC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 PLEASANT VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-6006
Mailing Address - Country:US
Mailing Address - Phone:314-323-5955
Mailing Address - Fax:
Practice Address - Street 1:22 PLEASANT VALLEY DR
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-6006
Practice Address - Country:US
Practice Address - Phone:314-323-5955
Practice Address - Fax:636-386-6698
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102630225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist