Provider Demographics
NPI:1518082361
Name:COYLE, ROBERTA (PTA)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:COYLE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-3331
Mailing Address - Country:US
Mailing Address - Phone:610-444-0420
Mailing Address - Fax:
Practice Address - Street 1:800 W MINER ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-2149
Practice Address - Country:US
Practice Address - Phone:610-738-3634
Practice Address - Fax:610-719-0567
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE000992L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant