Addison Coulter

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

Practice address

1275 N Convent St
Suite 3
Bourbonnais, IL 60914-8210

Phone

(815) 936-1855

Fax

(815) 936-6097

NPI assigned

Jun 15, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1465948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465948800000",
    "number": "1366892861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2223",
            "fax_number": "630-759-9510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 N CONVENT ST",
            "address_2": "SUITE 3",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609148210",
            "telephone_number": "815-936-1855",
            "fax_number": "815-936-6097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COULTER",
        "first_name": "ADDISON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-15",
        "last_updated": "2016-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tia Consolino
• Alan Blaine Coon, M.D., PH.D.
• Megan Corlett, MS, OTR/L
• Cornerstone Services Inc
• Cottage Clinic Counseling, Inc.
• Counseling With PS
• Ryan Grant Covarrubias, QMHP, LCSW
• Cody W Cowman, ATC
• Sarah Jeanette Coyne, FNP-BC
• Camille Crawford, PHARMD

• Physical Therapy Assistant in Bourbonnais, IL
• Providers in Bourbonnais, IL by specialty
• Physical Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2016; 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.