Individual
MICHAEL LLOYD COULTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
7411 112TH ST, BLUE GRASS, IA 52726-9121
(563) 343-4735
Mailing address
2141 10TH STREET PL, EAST MOLINE, IL 61244-2523
(309) 721-6289
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160003057
IL
Other
Enumeration date
12/13/2010
Last updated
12/13/2010
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