Active NPI
Laura Sample Coykendall, PT
- Physical Therapist
- Poulsbo, WA
National Provider Identifier
1437355153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT00003870
- Practice address
- 19319 7TH Ave NE Ste 108
Poulsbo, WA 98370-7442 - Phone
- (360) 779-3777
- Fax
- (360) 779-3797
- NPI assigned
- Jun 21, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT00003870 | WA | Primary |
| Clinical Electrophysiology Physical Therapist | 2251E1300X | PT0003870 | WA | |
| Geriatric Physical Therapist | 2251G0304X | PT0003870 | WA | |
| Hand Physical Therapist | 2251H1200X | PT0003870 | WA |
Addresses
Primary practice location
19319 7TH Ave NE Ste 108
Poulsbo, WA 98370-7442
Mailing address
2012 NW Kimball Rd
Poulsbo, WA 98370-9571
Phone (360) 697-1279
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4111589 | Medicaid | WA | |
| 911940669 | Other | TAX ID |
Other names 1
- Laura Gertrude Sample
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT00003870 | WA | MD | Physical Therapist |
| PT0003870 | WA | MD | Hand Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233014400000",
"number": "1437355153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2012 NW KIMBALL RD",
"city": "POULSBO",
"state": "WA",
"postal_code": "983709571",
"telephone_number": "360-697-1279"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19319 7TH AVE NE STE 108",
"city": "POULSBO",
"state": "WA",
"postal_code": "983707442",
"telephone_number": "360-779-3777",
"fax_number": "360-779-3797"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COYKENDALL",
"first_name": "LAURA",
"middle_name": "SAMPLE",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-21",
"last_updated": "2009-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "PT00003870",
"primary": true
},
{
"code": "2251E1300X",
"taxonomy_group": "",
"desc": "Physical Therapist, Electrophysiology, Clinical",
"state": "WA",
"license": "PT0003870",
"primary": false
},
{
"code": "2251G0304X",
"taxonomy_group": "",
"desc": "Physical Therapist, Geriatrics",
"state": "WA",
"license": "PT0003870",
"primary": false
},
{
"code": "2251H1200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Hand",
"state": "WA",
"license": "PT0003870",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4111589",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "911940669",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"first_name": "LAURA",
"last_name": "SAMPLE",
"middle_name": "GERTRUDE",
"credential": "PT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Poulsbo, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.