Provider Demographics
NPI:1225379191
Name:COYLE, PETER CHARLES (DPT)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:CHARLES
Last Name:COYLE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MARVIN DR APT A1
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-1361
Mailing Address - Country:US
Mailing Address - Phone:609-634-6321
Mailing Address - Fax:
Practice Address - Street 1:63 E DELAWARE AVE
Practice Address - Street 2:053 MCKINLY LAB
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19716-3798
Practice Address - Country:US
Practice Address - Phone:302-831-8893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002954225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist