Individual
GARY COGHLAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1717 QUINCEY LN, FAIRFIELD, CA 94534-2936
(707) 344-5350
Mailing address
1717 QUINCEY LN, FAIRFIELD, CA 94534-2936
(707) 344-5350
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT2891
CA
Other
Enumeration date
05/11/2017
Last updated
05/11/2017
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