Individual
COLIN G COUGHENOUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPT
Contact information
Practice address
18 WARRICK CT, PETALUMA, CA 94954-5848
(707) 217-7838
Mailing address
18 WARRICK CT, PETALUMA, CA 94954-5848
(707) 217-7838
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
ACE - T145486
CA
226300000X
Kinesiotherapist
Primary
ACE - T145486
CA
Other
Enumeration date
09/24/2009
Last updated
09/24/2009
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