Individual
ADDISON COULTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1275 N CONVENT ST, SUITE 3, BOURBONNAIS, IL 60914-8210
(815) 936-1855
(815) 936-6097
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
(630) 759-9510
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
IL
Other
Enumeration date
06/15/2016
Last updated
06/15/2016
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