Provider Demographics
NPI:1477623742
Name:COUGHLIN, KRYSTIN (LMP)
Entity Type:Individual
Prefix:
First Name:KRYSTIN
Middle Name:
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:KRYSTIN
Other - Middle Name:
Other - Last Name:DURKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:4017 A ST SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-8607
Mailing Address - Country:US
Mailing Address - Phone:253-939-8144
Mailing Address - Fax:
Practice Address - Street 1:4017 A ST SE
Practice Address - Street 2:SUITE 101
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-8607
Practice Address - Country:US
Practice Address - Phone:253-939-8144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021060225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3669COOtherREGENCE BLUE SHIELD
WA198448OtherDEPT OF LABOR & INDUSTRY
WA8906263OtherCRIME VICTIMS