Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2115 | TN |
NPI | 1003183740 |
---|---|
Provider Name | Mrs. Yvonne Jeanette Coulter |
First Address | Ooltewah, TN 37363-6668 |
Second Address | Hixson, TN 37343-3941 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2011 |
Last Update Date | 23/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12311815 | CAQH (01) | TN |