Provider Demographics
NPI:1386214179
Name:COACH, JURELL
Entity Type:Individual
Prefix:
First Name:JURELL
Middle Name:
Last Name:COACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 EDGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3530
Mailing Address - Country:US
Mailing Address - Phone:803-640-3179
Mailing Address - Fax:
Practice Address - Street 1:320 EDGEWOOD CT
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3530
Practice Address - Country:US
Practice Address - Phone:803-640-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer