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General NPI Number Information
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NPI Number | 1689644841
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Entity Type | Individual
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Provider Name | TRACY COULTON MSPT
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Gender | Female
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 167 MAIN ST
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City | SOUTHAMPTON
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State | NY
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Zip | 11968-4823
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Country | US
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Telephone | 631-283-4190
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Fax | 631-283-7650
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Provider Business Mailing Address
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Address Line | 5 GARDENIA AVE
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City | HAMPTON BAYS
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State | NY
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Zip | 11946-2823
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Country | US
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Telephone | 631-283-4190
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Fax | 631-283-7650
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 012072-1
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License Number State | NY
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