Provider Demographics
NPI:1437662285
Name:COYNE, BETHANY (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:COYNE
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:HUBBARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1304 S SYLVAN AVE
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801
Mailing Address - Country:US
Mailing Address - Phone:936-425-6162
Mailing Address - Fax:
Practice Address - Street 1:1304 S SYLVAN AVE
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-5137
Practice Address - Country:US
Practice Address - Phone:936-425-6162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT63592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer