Healthcare Provider Details

I. General information

NPI: 1972848679
Provider Name (Legal Business Name): KATHERINE ANNE COUGHLIN LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 NORTH ST
NORTH READING MA
01864-1315
US

IV. Provider business mailing address

10 BURDITT RD
NORTH READING MA
01864-2115
US

V. Phone/Fax

Practice location:
  • Phone: 978-276-2000
  • Fax: 978-276-1279
Mailing address:
  • Phone: 978-276-2000
  • Fax: 978-279-1279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number131
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: