Provider Demographics
NPI:1023390069
Name:COAKLEY, COLLEEN (PT, OCS, CIMT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:COAKLEY
Suffix:
Gender:F
Credentials:PT, OCS, CIMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8324 E MACKENZIE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-2811
Mailing Address - Country:US
Mailing Address - Phone:480-209-4855
Mailing Address - Fax:
Practice Address - Street 1:7301 E 2ND ST STE 90
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5600
Practice Address - Country:US
Practice Address - Phone:480-994-1149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42462251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic