Individual
MRS. LAURA SAMPLE COYKENDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
19319 7TH AVE NE STE 108, POULSBO, WA 98370-7442
(360) 779-3777
(360) 779-3797
Mailing address
2012 NW KIMBALL RD, POULSBO, WA 98370-9571
(360) 697-1279
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00003870
WA
2251E1300X
Clinical Electrophysiology Physical Therapist
PT0003870
WA
2251G0304X
Geriatric Physical Therapist
PT0003870
WA
2251H1200X
Hand Physical Therapist
PT0003870
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4111589
—
WA
01
—
911940669
TAX ID
—
Enumeration date
06/21/2007
Last updated
01/27/2009
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