Provider Demographics
NPI:1194138073
Name:COAN, CORI R (PTA)
Entity type:Individual
Prefix:MS
First Name:CORI
Middle Name:R
Last Name:COAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 S ROCHDALE AVE
Mailing Address - Street 2:PO BOX 434
Mailing Address - City:ROOSEVELT
Mailing Address - State:NJ
Mailing Address - Zip Code:08555-7012
Mailing Address - Country:US
Mailing Address - Phone:732-330-8757
Mailing Address - Fax:
Practice Address - Street 1:294 APPLEGARTH RD
Practice Address - Street 2:SUITE C
Practice Address - City:MONROE
Practice Address - State:NJ
Practice Address - Zip Code:08831-3798
Practice Address - Country:US
Practice Address - Phone:609-495-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00211500225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant