Provider Demographics
NPI:1679812754
Name:COAKLEY, AMY M (PT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:COAKLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 DEBORAH DR
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-2317
Mailing Address - Country:US
Mailing Address - Phone:508-505-5060
Mailing Address - Fax:
Practice Address - Street 1:24 DEBORAH DR
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-2317
Practice Address - Country:US
Practice Address - Phone:508-505-5060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7033225100000X
RIPT01843225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist