Healthcare Provider Details

I. General information

NPI: 1225379191
Provider Name (Legal Business Name): PETER CHARLES COYLE D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 E DELAWARE AVE 053 MCKINLY LAB
NEWARK DE
19716-3798
US

IV. Provider business mailing address

18 MARVIN DR APT A1
NEWARK DE
19713-1361
US

V. Phone/Fax

Practice location:
  • Phone: 302-831-8893
  • Fax:
Mailing address:
  • Phone: 609-634-6321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0002954
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: