Provider Demographics
NPI:1164407805
Name:COKER, JOHN DAVID (MPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:COKER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 631
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75151-0631
Mailing Address - Country:US
Mailing Address - Phone:903-872-7229
Mailing Address - Fax:
Practice Address - Street 1:400 OAKLAWN AVE
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2937
Practice Address - Country:US
Practice Address - Phone:903-872-2412
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1120657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN8T4429OtherBCBS
TXS96752Medicare UPIN
TX8F1040Medicare ID - Type Unspecified