Provider Demographics
NPI:1376503342
Name:COULTER, JAMES WESLEY (PT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WESLEY
Last Name:COULTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:1952 ABERDEEN CT
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3175
Mailing Address - Country:US
Mailing Address - Phone:815-758-0000
Mailing Address - Fax:815-748-3014
Practice Address - Street 1:1513 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-2703
Practice Address - Country:US
Practice Address - Phone:815-758-0000
Practice Address - Fax:815-991-9484
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070002845225100000X
IL070-0028452251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist