Provider Demographics
NPI:1689804072
Name:COAN, TIMOTHY KITT (RPT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:KITT
Last Name:COAN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 OWENS ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35904-4938
Mailing Address - Country:US
Mailing Address - Phone:256-543-1030
Mailing Address - Fax:256-439-2830
Practice Address - Street 1:1514 OWENS ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35904-4938
Practice Address - Country:US
Practice Address - Phone:256-543-1030
Practice Address - Fax:256-439-2830
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH5587225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL200907931OtherPTH 5587