Provider Demographics
NPI:1912681289
Name:COATES, KELDEN
Entity Type:Individual
Prefix:
First Name:KELDEN
Middle Name:
Last Name:COATES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 SW 13TH ST APT 508
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-4381
Mailing Address - Country:US
Mailing Address - Phone:850-510-4491
Mailing Address - Fax:
Practice Address - Street 1:145 SW 13TH ST APT 508
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-4381
Practice Address - Country:US
Practice Address - Phone:850-510-4491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL39633225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist