Healthcare Provider Details

I. General information

NPI: 1649976010
Provider Name (Legal Business Name): HAYLEY COKER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E GRANT ST STE 110
MACOMB IL
61455-3308
US

IV. Provider business mailing address

16135 N 1050TH RD
MACOMB IL
61455-8594
US

V. Phone/Fax

Practice location:
  • Phone: 309-833-1733
  • Fax: 309-836-2369
Mailing address:
  • Phone: 309-333-7937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070029861
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number117099
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305215596
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: