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General NPI Number Information
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NPI Number | 1659605574
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Entity Type | Individual
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Provider Name | COLIN G COUGHENOUR CPT
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Gender | Male
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Dates
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Enumeration Date | 09/24/2009
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Last Update Date | 09/24/2009
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Provider Practice Location Address
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Address Line | 18 WARRICK CT
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City | PETALUMA
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State | CA
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Zip | 94954-5848
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Country | US
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Telephone | 707-217-7838
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Fax |
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Provider Business Mailing Address
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Address Line | 18 WARRICK CT
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City | PETALUMA
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State | CA
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Zip | 94954-5848
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Country | US
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Telephone | 707-217-7838
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | ACE - T145486
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 226300000X
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Taxonomy Name | Kinesiotherapist
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License Number | ACE - T145486
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License Number State | CA
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