Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | P1 60045885 | WA |
NPI | 1003195090 |
---|---|
Provider Name | Amy Lachelle Coe |
First Address | Puyallup, WA 98372-3709 |
Second Address | Puyallup, WA 98372-3709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2011 |
Last Update Date | 09/08/2011 |