Provider Demographics
NPI:1598459703
Name:COKER, TRISTAN A (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:TRISTAN
Middle Name:A
Last Name:COKER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:946 GOSS AVE APT 1144
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1299
Mailing Address - Country:US
Mailing Address - Phone:260-579-3321
Mailing Address - Fax:
Practice Address - Street 1:9880 ANGIES WAY STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2851
Practice Address - Country:US
Practice Address - Phone:502-339-6490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0089342251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic