Healthcare Provider Details

I. General information

NPI: 1326423054
Provider Name (Legal Business Name): RACHEL COFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL TARINI

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 TOMPKINS ST
WATERBURY CT
06708-1458
US

IV. Provider business mailing address

1625 STRAITS TURNPIKE SUITE 300
MIDDLEBURY CT
06762-1805
US

V. Phone/Fax

Practice location:
  • Phone: 203-419-0381
  • Fax: 203-419-0389
Mailing address:
  • Phone: 203-598-6066
  • Fax: 203-598-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10213
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: