Basic Information
| Provider Information | |||||||||
| NPI: | 1831725928 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COFFMAN | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2373 CARTHAGE RD | ||||||||
| Address2: | |||||||||
| City: | CALIFORNIA | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410079223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8597602930 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 DOLWICK DR | ||||||||
| Address2: | |||||||||
| City: | ERLANGER | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410183231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593015600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2020 | ||||||||
| LastUpdateDate: | 03/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | AT329 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.