Individual
MARY ELIZABETH COUGHLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
967 PINTAIL LANE, CHARLOTTESVILLE, VA 22903-9616
(434) 284-2550
Mailing address
967 PINTAIL LN, CHARLOTTESVILLE, VA 22903-9616
(434) 284-2550
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305204980
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2305204980
STATE OF VIRGINIA PHYSICAL THERAPY LICENSE NUMBER
VA
Enumeration date
09/28/2006
Last updated
08/02/2011
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