Provider Demographics
NPI:1134339708
Name:LAWLER-COYLE, KIM LORI (PT)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:LORI
Last Name:LAWLER-COYLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:KIM
Other - Middle Name:LORI
Other - Last Name:LAWLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1601 DOVE ST STE 210
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1422
Mailing Address - Country:US
Mailing Address - Phone:949-851-8121
Mailing Address - Fax:949-258-5861
Practice Address - Street 1:1601 DOVE ST STE 210
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1422
Practice Address - Country:US
Practice Address - Phone:949-851-8121
Practice Address - Fax:949-258-5861
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10755225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist