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General NPI Number Information
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NPI Number | 1679734388
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Entity Type | Individual
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Provider Name | THERESA COOMER PT
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Gender | Female
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Dates
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Enumeration Date | 06/24/2008
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Last Update Date | 03/06/2009
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Provider Practice Location Address
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Address Line | 5751 PRESTON HWY STE 101
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City | LOUISVILLE
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State | KY
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Zip | 40219-1349
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Country | US
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Telephone | 502-807-4110
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Fax | 502-384-4791
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Provider Business Mailing Address
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Address Line | PO BOX 572
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City | CRESTWOOD
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State | KY
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Zip | 40014-0572
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Country | US
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Telephone | 502-807-4110
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Fax | 502-384-4791
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 001018
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License Number State | KY
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