Provider Demographics
NPI:1255773891
Name:COETZEE, ELAINE
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:COETZEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3158 CHARLES MACDONALD DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8711
Mailing Address - Country:US
Mailing Address - Phone:321-662-8809
Mailing Address - Fax:941-343-9402
Practice Address - Street 1:3158 CHARLES MACDONALD DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-8711
Practice Address - Country:US
Practice Address - Phone:321-662-8809
Practice Address - Fax:941-343-9402
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1229060225100000X
FL28097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist