Individual
MRS. CARRIE ANN COEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
678 SOUTHWAY AVE, LEWISTON, ID 83501-3783
(208) 746-1418
(208) 746-4123
Mailing address
678 SOUTHWAY AVE, LEWISTON, ID 83501-3783
(208) 746-1418
(208) 746-4123
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0112038
WA LI
ID
01
—
1000927
CHAMPUS/BLUECROSS
ID
01
—
390090
REGENCE GROUP
ID
01
—
7023864
WAPA
ID
01
—
8B263
BCID
ID
Enumeration date
10/19/2006
Last updated
07/08/2007
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