Provider Demographics
NPI:1770627952
Name:COYNER, PRISCILLA ANNE (MPT PCS)
Entity Type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:ANNE
Last Name:COYNER
Suffix:
Gender:F
Credentials:MPT PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14917 256TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8333
Mailing Address - Country:US
Mailing Address - Phone:425-392-7989
Mailing Address - Fax:425-391-2554
Practice Address - Street 1:710 NW JUNIPER ST
Practice Address - Street 2:SUITE104
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2717
Practice Address - Country:US
Practice Address - Phone:425-392-7989
Practice Address - Fax:425-391-2554
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACO2118OtherREGENCE
WA7038037Medicaid