Healthcare Provider Details

I. General information

NPI: 1245670124
Provider Name (Legal Business Name): LAURA RAE COFFEY MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 STATE RD 3444
ANNVILLE KY
40402
US

IV. Provider business mailing address

3104 PINE TOP RD
LONDON KY
40741-6202
US

V. Phone/Fax

Practice location:
  • Phone: 606-364-2260
  • Fax: 606-364-5187
Mailing address:
  • Phone: 606-862-8333
  • Fax: 606-862-8618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004849
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: