Provider Demographics
NPI:1629540158
Name:COALE, KATHLEEN D (PT, DPT, CEEAA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:D
Last Name:COALE
Suffix:
Gender:F
Credentials:PT, DPT, CEEAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HERITAGE PLACE, BUILDING 1, SUITE 101
Mailing Address - Street 2:439 SOUTH UNION STREET
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843
Mailing Address - Country:US
Mailing Address - Phone:978-686-2983
Mailing Address - Fax:978-686-0684
Practice Address - Street 1:HERITAGE PLACE, BUILDING 1, SUITE 101
Practice Address - Street 2:439 SOUTH UNION STREET
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843
Practice Address - Country:US
Practice Address - Phone:978-686-2983
Practice Address - Fax:978-686-0684
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist