1689667925 NPI number — VALERIE L COOLMAN P.T.

Table of content: VALERIE L COOLMAN P.T. (NPI 1689667925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689667925 NPI number — VALERIE L COOLMAN P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOLMAN
Provider First Name:
VALERIE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689667925
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9602 COLDWATER RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
FORT WAYNE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46825-2095
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-489-9887
Provider Business Mailing Address Fax Number:
260-489-9121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9602 COLDWATER RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46825-2095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-489-9887
Provider Business Practice Location Address Fax Number:
260-489-9121
Provider Enumeration Date:
08/23/2005

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: 225100000X , with the licence number:  05007762A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200339230 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com