MEDICARE: MICHAEL COULSON DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	LPT-034017	AZ

General Provider Information

NPI Number	:	1396555959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL COULSON DPT

Provider Business Mailing Address
First Line	:	21427 S 231ST WAY
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-0828
Country	:	US
Telephone Number	:	509-400-1068
Fax Number	:

Provider Business Practice Location Address
First Line	:	20851 E RITTENHOUSE RD # E103
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-4493
Country	:	US
Telephone Number	:	480-677-3294
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2025
Last Update Date	:	01/07/2025

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Directions to “ MICHAEL COULSON DPT” Practice Location

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