Individual
DR. ADAM THADDEUS COUGHLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
12490 W FIELDING CIR APT 174, PLAYA VISTA, CA 90094-3024
(424) 216-7239
Mailing address
7150 TAMPA AVE, RESEDA, CA 91335-3700
(818) 757-4447
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
301863
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
301863
PHYSICAL THERAPY LICENSE
CA
Enumeration date
10/04/2022
Last updated
10/04/2022
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