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General NPI Number Information
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NPI Number | 1477026235
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Entity Type | Individual
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Provider Name | NICKOLAS COYLE MS, LAT, ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 01/04/2019
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Last Update Date | 05/27/2022
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Provider Practice Location Address
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Address Line | 55 HARBOUR BLVD
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City | CAMDEN
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State | NJ
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Zip | 08103-1056
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Country | US
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Telephone | 515-480-1887
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Fax |
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Provider Business Mailing Address
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Address Line | 55 HARBOUR BLVD
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City | CAMDEN
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State | NJ
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Zip | 08103-1056
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Country | US
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Telephone | 515-480-1887
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2446
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | NJ
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