Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 009240 | GA |
NPI | 1073656526 |
---|---|
Provider Name | Mrs. Nikki Lynn Coyne |
First Address | Marietta, GA 30064-3973 |
Second Address | Marietta, GA 30064-3973 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 18/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
393730 | BCBS OF GA (01) | GA |