Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 4148218L | PA |
NPI | 1194078212 |
---|---|
Provider Name | Mrs. Lorie Lynn Coole-Foust |
First Address | Bryn Mawr, PA 19010-2920 |
Second Address | Glen Mills, PA 19342-8122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2012 |
Last Update Date | 26/10/2012 |