Provider Demographics
NPI:1790465615
Name:COFFELL, JOSHUA (LMT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:COFFELL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 BUFFALO VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-3103
Mailing Address - Country:US
Mailing Address - Phone:931-239-3513
Mailing Address - Fax:
Practice Address - Street 1:721 BUFFALO VALLEY RD
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3103
Practice Address - Country:US
Practice Address - Phone:931-239-3513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14391225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist