MEDICARE: DANIEL COTHERN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	2286	AR
2	174400000X	Specialist	PT 2286	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871694471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL COTHERN

Provider Business Mailing Address
First Line	:	PO BOX 13525
Second Line	:
City	:	MAUMELLE
State	:	AR
Zip	:	72113-0525
Country	:	US
Telephone Number	:	866-251-1227
Fax Number	:	866-251-1267

Provider Business Practice Location Address
First Line	:	1998 W GRAND BLVD
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72704-5077
Country	:	US
Telephone Number	:	866-251-1227
Fax Number	:	866-251-1267

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	03/13/2026

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Directions to “ DANIEL COTHERN ” Practice Location

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