Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A02641 | KY |
NPI | 1003108366 |
---|---|
Provider Name | Mr. Jeremy R. Coakley |
First Address | Greenville, KY 42345-1409 |
Second Address | Greenville, KY 42345-1409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2011 |
Last Update Date | 05/05/2011 |