Healthcare Provider Details

I. General information

NPI: 1811310493
Provider Name (Legal Business Name): LINDA COFFEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2014
Last Update Date: 02/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 JARVIS AVE
HOLYOKE MA
01040-1288
US

IV. Provider business mailing address

1556 PIPER RD
WEST SPRINGFIELD MA
01089-4593
US

V. Phone/Fax

Practice location:
  • Phone: 413-315-5884
  • Fax: 413-315-5886
Mailing address:
  • Phone: 413-315-5884
  • Fax: 413-315-5886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number670
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: