Provider Demographics
NPI:1669449088
Name:COFFELT, DAWN COLETTE (MS PT)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:COLETTE
Last Name:COFFELT
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2200 COUNTRY BROOK DR.
Mailing Address - Street 2:APT. 2110
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:817-498-8702
Practice Address - Street 1:2200 COUNTRY BROOK DR.
Practice Address - Street 2:APT. 2110
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-1616
Practice Address - Country:US
Practice Address - Phone:970-215-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1142008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX456844Medicare ID - Type Unspecified