Provider Demographics
NPI:1427745207
Name:COYLE, JENNIFER MICHELE (LMT,CMLDT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MICHELE
Last Name:COYLE
Suffix:
Gender:F
Credentials:LMT,CMLDT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MICHELE
Other - Last Name:COYLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT,CMLDT
Mailing Address - Street 1:8201 MONTERO DR
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-9407
Mailing Address - Country:US
Mailing Address - Phone:502-432-6491
Mailing Address - Fax:
Practice Address - Street 1:4400 BRECKENRIDGE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-4135
Practice Address - Country:US
Practice Address - Phone:502-242-8318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY165604225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist