MEDICARE: JILL KATHLEEN COOGAN LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT134676	TX

General Provider Information

NPI Number	:	1447929559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL KATHLEEN COOGAN LMT

Provider Business Mailing Address
First Line	:	4825 DAVIS LN APT 1426
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-4578
Country	:	US
Telephone Number	:	818-274-9977
Fax Number	:

Provider Business Practice Location Address
First Line	:	4825 DAVIS LN APT 1426
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-4578
Country	:	US
Telephone Number	:	818-274-9977
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2021
Last Update Date	:	03/15/2026

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