Healthcare Provider Details

I. General information

NPI: 1982959896
Provider Name (Legal Business Name): AMANDA MICHELLE COUGHLIN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8031 W CENTER RD SUITE #300
OMAHA NE
68124-3158
US

IV. Provider business mailing address

3220 FARNAM ST APT 2711
OMAHA NE
68131-3520
US

V. Phone/Fax

Practice location:
  • Phone: 402-391-5002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3137
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: