Provider Demographics
NPI:1598998056
Name:COUGHENOUR, ERIN J (DPT)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:J
Last Name:COUGHENOUR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 EASTLAND BLVD
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-4104
Mailing Address - Country:US
Mailing Address - Phone:727-797-7600
Mailing Address - Fax:727-797-7655
Practice Address - Street 1:3001 EASTLAND BLVD
Practice Address - Street 2:SUITE 3B
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-4104
Practice Address - Country:US
Practice Address - Phone:727-797-7600
Practice Address - Fax:727-797-7655
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6054225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY05E2OtherBCBS
FLDH8162Medicare PIN