Provider Demographics
NPI:1942359872
Name:TERRY J COY
Entity Type:Organization
Organization Name:TERRY J COY
Other - Org Name:POINTE EAST PHYSICAL REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:COY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-288-5229
Mailing Address - Street 1:3407 S STATE ROUTE 157
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-1042
Mailing Address - Country:US
Mailing Address - Phone:618-288-5229
Mailing Address - Fax:618-288-9879
Practice Address - Street 1:3407 S STATE ROUTE 157
Practice Address - Street 2:SUITE 2
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-1042
Practice Address - Country:US
Practice Address - Phone:618-288-5229
Practice Address - Fax:618-288-9879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208371OtherMEDICARE PTAN
IL=========OtherTAX ID