Individual
BLAKE COUGHENOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
128 W HICKMAN RD, WAUKEE, IA 50263-5070
(515) 309-1819
Mailing address
2122 YORK RD STE 300, OAK BROOK, IL 60523-1925
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
124144
IA
Other
Enumeration date
04/29/2024
Last updated
05/28/2024
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