Provider Demographics
NPI:1336138270
Name:COUGHLIN, STEPHANIE M (PT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:M
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:M
Other - Last Name:VANDENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5537 205TH LN
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:IA
Mailing Address - Zip Code:52569-8507
Mailing Address - Country:US
Mailing Address - Phone:641-891-9863
Mailing Address - Fax:
Practice Address - Street 1:5537 205TH LN
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:IA
Practice Address - Zip Code:52569-8507
Practice Address - Country:US
Practice Address - Phone:641-891-9863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist