Provider Demographics
NPI:1255154241
Name:MCCOY, BRIANN MARIE (CMT)
Entity type:Individual
Prefix:
First Name:BRIANN
Middle Name:MARIE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5733 SHATTUCK AVE APT A
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1640
Mailing Address - Country:US
Mailing Address - Phone:415-385-9746
Mailing Address - Fax:
Practice Address - Street 1:3132 24TH ST # B
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4012
Practice Address - Country:US
Practice Address - Phone:415-385-9746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54249225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist