Provider Demographics
NPI:1720074511
Name:COAKLEY, ANNE (PT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:COAKLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 NATIONAL DR
Mailing Address - Street 2:STE 100
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1176
Mailing Address - Country:US
Mailing Address - Phone:301-421-1125
Mailing Address - Fax:301-500-2175
Practice Address - Street 1:6011 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6074
Practice Address - Country:US
Practice Address - Phone:410-203-0391
Practice Address - Fax:410-203-2707
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD164632251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD075355600Medicaid
MD236394OtherMAMSI
MD6545-0005OtherBLUE CHOICE
MD6545-0005OtherBLUE CHOICE