Provider Demographics
NPI:1245670124
Name:COFFEY, LAURA RAE (MPT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:RAE
Last Name:COFFEY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 PINE TOP RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-6202
Mailing Address - Country:US
Mailing Address - Phone:606-862-8333
Mailing Address - Fax:606-862-8618
Practice Address - Street 1:69 STATE RD 3444
Practice Address - Street 2:
Practice Address - City:ANNVILLE
Practice Address - State:KY
Practice Address - Zip Code:40402
Practice Address - Country:US
Practice Address - Phone:606-364-2260
Practice Address - Fax:606-364-5187
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004849225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist