Provider Demographics
NPI:1275721292
Name:COKER, MICHAEL THOMAS (LMT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:THOMAS
Last Name:COKER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 E MERRITT ISLAND CSWY
Mailing Address - Street 2:SUITE 11
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3675
Mailing Address - Country:US
Mailing Address - Phone:321-453-4482
Mailing Address - Fax:
Practice Address - Street 1:262 E MERRITT ISLAND CSWY
Practice Address - Street 2:SUITE 11
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3675
Practice Address - Country:US
Practice Address - Phone:321-453-4482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA29960225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist