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NPI Code Detail

MEDICARE: ELIZABETH NICOLE COONS PTA

MEDICARE: ELIZABETH NICOLE COONS PTA
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
1225200000XPhysical Therapy Assistant06005515AIN

General Provider Information

NPI Number : 1912624107
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH NICOLE COONS PTA
Provider Business Mailing Address
First Line : 1619 S 9TH AVE
Second Line :
City : BEECH GROVE
State : IN
Zip : 46107-2556
Country : US
Telephone Number : 317-509-4328
Fax Number :
Provider Business Practice Location Address
First Line : 8400 CLEARVISTA PL # 3D
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46256-3700
Country : US
Telephone Number : 317-509-4328
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2022
Last Update Date : 10/27/2022

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