Individual
MRS. SUZANNE S COFFMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1322 LOCUST AVE, FAIRMONT, WV 26554
(304) 367-8740
(304) 366-9529
Mailing address
RR 4 BOX 286, GRAFTON, WV 26354
(304) 265-5643
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
133
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001718501
BLUE CROSS BLUE SHIELD
WV
05
—
0156077001
—
WV
01
—
55041919103
BRICKSTREET
WV
Enumeration date
09/06/2006
Last updated
09/10/2012
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