Jaimie Lee Coulombe, PT, DPT

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

PT 39626 Issued in CA

Practice address

35 Michigan St NE # 4128
Grand Rapids, MI 49503-2514

Phone

(616) 267-2727

NPI assigned

Jan 29, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• South Coast Pediatric Physical Therapy, Inc

  • Speech-Language Pathologist
  • Cypress, CA
  • NPI 1467604694

  Pediatrics

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1359417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1316285190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3052 CREEK WAY CT SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495129163",
            "telephone_number": "760-985-0417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 MICHIGAN ST NE # 4128",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032514",
            "telephone_number": "616-267-2727"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11105 Knott Ave",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Cypress",
            "state": "CA",
            "postal_code": "906305137",
            "country_code": "US",
            "telephone_number": "714-893-7399 x127",
            "fax_number": "714-893-7389",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COULOMBE",
        "first_name": "JAIMIE",
        "middle_name": "LEE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-29",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT39626",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501018246",
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "CA",
            "license": "PT 39626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blair J Cotton, PA-C
• Ebone Nicole Cotton
• Eliana Couch
• Wanda L Couch, LPC
• Jaimie Lynn Coucke, PA
• Counseling Associates of West Michigan LLC
• Counseling Associates of West Michigan LLC
• Counseling Center for Restoration Transformation and Play LLC
• Counseling Center of West Michigan, LLC
• Counterstrain Physical Therapy PLLC

• Pediatric Physical Therapist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Pediatric Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.