Provider Demographics
NPI:1477669372
Name:COYNE, NANCY WESLYNN (PT)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:WESLYNN
Last Name:COYNE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24060 LORAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070
Mailing Address - Country:US
Mailing Address - Phone:440-779-4226
Mailing Address - Fax:440-779-4205
Practice Address - Street 1:24060 LORAIN ROAD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070
Practice Address - Country:US
Practice Address - Phone:440-779-4226
Practice Address - Fax:440-779-4205
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000385454OtherANTHEM BLUE CROSS
OH2617814Medicaid
OH22660681001OtherMMOH
OH2617814Medicaid