Provider Demographics
NPI:1003183740
Name:COULTER, YVONNE JEANETTE (PT)
Entity Type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:JEANETTE
Last Name:COULTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:YVONNE
Other - Middle Name:JEANETTE
Other - Last Name:DELISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6711 MOUNTAIN VIEW RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6668
Mailing Address - Country:US
Mailing Address - Phone:423-238-1127
Mailing Address - Fax:423-238-1277
Practice Address - Street 1:5035 HIXSON PIKE
Practice Address - Street 2:SUITE 129
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3941
Practice Address - Country:US
Practice Address - Phone:423-521-4997
Practice Address - Fax:423-521-4999
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2115225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN12311815OtherCAQH