Healthcare Provider Details

I. General information

NPI: 1326069410
Provider Name (Legal Business Name): ERICA M COIL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 FAIRWAY DR SUITE C
FULTON MO
65251-3936
US

IV. Provider business mailing address

3301 BERRYWOOD DR SUITE 204
COLUMBIA MO
65201-6517
US

V. Phone/Fax

Practice location:
  • Phone: 573-592-7750
  • Fax: 573-592-7751
Mailing address:
  • Phone: 573-449-8771
  • Fax: 573-449-6563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2004005135
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: