Provider Demographics
NPI:1790407872
Name:COAKLEY, LORI KAYE (PTA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:KAYE
Last Name:COAKLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5305 CHAPERITO TRL
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-2224
Mailing Address - Country:US
Mailing Address - Phone:214-957-6858
Mailing Address - Fax:
Practice Address - Street 1:5305 CHAPERITO TRL
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-2224
Practice Address - Country:US
Practice Address - Phone:214-957-6858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2059150225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty