=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134339708
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIM LORI LAWLER-COYLE P.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2007
-----------------------------------------------------
Last Update Date | 11/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1601 DOVE ST STE 210
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92660-1422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-851-8121
-----------------------------------------------------
Fax | 949-258-5861
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1601 DOVE ST STE 210
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92660-1422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-851-8121
-----------------------------------------------------
Fax | 949-258-5861
-----------------------------------------------------
=====================================================
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 | PT10755
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------