Provider Demographics
NPI:1588790513
Name:COFFEY, WILLIAM MARK (LAT, CSCS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MARK
Last Name:COFFEY
Suffix:
Gender:M
Credentials:LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 KOSMAS ST
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-2535
Mailing Address - Country:US
Mailing Address - Phone:508-460-0342
Mailing Address - Fax:508-213-2446
Practice Address - Street 1:119 CENTER ROAD
Practice Address - Street 2:
Practice Address - City:DUDLEY
Practice Address - State:MA
Practice Address - Zip Code:01571
Practice Address - Country:US
Practice Address - Phone:508-213-2261
Practice Address - Fax:508-213-2446
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1426-AT2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer