=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093454704
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRITTANY COOLIDGE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2022
-----------------------------------------------------
Last Update Date | 06/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44 CHATEAU BLVD
-----------------------------------------------------
City | BATESVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47006-5744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-933-8268
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2737 FLAGSTONE DR
-----------------------------------------------------
City | WEST HARRISON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47060-6638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 05014578A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------