Healthcare Provider Details

I. General information

NPI: 1730247263
Provider Name (Legal Business Name): MICHAEL A COALSON L.P.T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N CALDWELL ST
STAUNTON IL
62088-1423
US

IV. Provider business mailing address

1719 CLAWSON ST
ALTON IL
62002-4702
US

V. Phone/Fax

Practice location:
  • Phone: 618-635-4273
  • Fax: 618-635-4272
Mailing address:
  • Phone: 161-846-2113
  • Fax: 161-846-2373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: