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General NPI Number Information
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NPI Number | 1427745207
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Entity Type | Individual
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Provider Name | JENNIFER MICHELE COYLE LMT,CMLDT
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Gender | Female
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Dates
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Enumeration Date | 04/20/2023
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Last Update Date | 04/20/2023
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Provider Practice Location Address
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Address Line | 4400 BRECKENRIDGE LN
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City | LOUISVILLE
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State | KY
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Zip | 40218-4135
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Country | US
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Telephone | 502-242-8318
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Fax |
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Provider Business Mailing Address
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Address Line | 8201 MONTERO DR
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City | PROSPECT
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State | KY
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Zip | 40059-9407
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Country | US
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Telephone | 502-432-6491
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 165604
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License Number State | KY
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