Provider Demographics
NPI:1184722449
Name:COATES, ANNETTE LEIGH (MPT)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:LEIGH
Last Name:COATES
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:LEIGH
Other - Last Name:KITTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1242 STATE AVE
Practice Address - Street 2:STE A
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-3672
Practice Address - Country:US
Practice Address - Phone:360-572-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7155104Medicaid
WAG8862633Medicare PIN