Provider Demographics
NPI:1255316097
Name:COUGHLIN, MARY ANN (PT)
Entity Type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARY ANN
Other - Middle Name:
Other - Last Name:ZABER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7101 NARROWS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1805
Mailing Address - Country:US
Mailing Address - Phone:718-921-7031
Mailing Address - Fax:718-921-1040
Practice Address - Street 1:7101 NARROWS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1805
Practice Address - Country:US
Practice Address - Phone:718-921-7031
Practice Address - Fax:718-921-1040
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0708225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ54692Medicare UPIN