1245798438 NPI number — MRS. NICOLE CHRISTINE CODDINGTON LAT, ATC

Table of content: MRS. NICOLE CHRISTINE CODDINGTON LAT, ATC (NPI 1245798438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245798438 NPI number — MRS. NICOLE CHRISTINE CODDINGTON LAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CODDINGTON
Provider First Name:
NICOLE
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LAT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ARZBERGER
Provider Other First Name:
NICOLE
Provider Other Middle Name:
CHRISTINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LAT, ATC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245798438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5201 BRIDGEWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KILLEEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76549-5650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-520-6163
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2401 S 31ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76508-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-724-9585
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  7368 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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