Provider Demographics
NPI:1427058254
Name:COUGHLIN, ROBERT A (PT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:COUGHLIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1867
Mailing Address - Country:US
Mailing Address - Phone:207-282-7121
Mailing Address - Fax:207-282-0073
Practice Address - Street 1:400 NORTH ST
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1867
Practice Address - Country:US
Practice Address - Phone:207-282-7121
Practice Address - Fax:207-282-0073
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME040668OtherBC/BS OF MAINE
ME08Y003785ME01OtherBC/BS OF NH
ME040668OtherBC/BS OF MAINE