Provider Demographics
NPI:1508970237
Name:COKER, EDDIE EUGENE (RKT)
Entity Type:Individual
Prefix:MR
First Name:EDDIE
Middle Name:EUGENE
Last Name:COKER
Suffix:
Gender:M
Credentials:RKT
Other - Prefix:MR
Other - First Name:EDDIE
Other - Middle Name:EUGENE
Other - Last Name:COKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:KINESIOTHERAPIST
Mailing Address - Street 1:7557 GHOLSON RD
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76705-5340
Mailing Address - Country:US
Mailing Address - Phone:254-829-0277
Mailing Address - Fax:
Practice Address - Street 1:4800 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711-1329
Practice Address - Country:US
Practice Address - Phone:254-297-2290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist