Healthcare Provider Details

I. General information

NPI: 1548196264
Provider Name (Legal Business Name): KRISTIN JEAN COFFEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 E 7TH ST
AUBURN IN
46706-2538
US

IV. Provider business mailing address

8433 TEWKSBURY CT
FORT WAYNE IN
46835-8306
US

V. Phone/Fax

Practice location:
  • Phone: 260-920-2632
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05007157A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: