Individual
ERIC C COUGHLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
0400003482
VT
225100000X
Physical Therapist
Primary
4706
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
232085
—
OR
01
—
P01384716
RR MEDICARE PTAN
OR
Enumeration date
12/13/2005
Last updated
01/05/2015
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