=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114122926
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA COINS PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2007
-----------------------------------------------------
Last Update Date | 07/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 PEACHTREE STREET L231
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-413-8131
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 AZALEA GARDEN DRIVE APT 2205
-----------------------------------------------------
City | DUNWOODY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-413-8131
-----------------------------------------------------
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 | PT009039
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 2305208429
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------