Healthcare Provider Details

I. General information

NPI: 1427058254
Provider Name (Legal Business Name): ROBERT A COUGHLIN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NORTH ST
SACO ME
04072-1867
US

IV. Provider business mailing address

400 NORTH ST
SACO ME
04072-1867
US

V. Phone/Fax

Practice location:
  • Phone: 207-282-7121
  • Fax: 207-282-0073
Mailing address:
  • Phone: 207-282-7121
  • Fax: 207-282-0073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1996
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: