Provider Demographics
NPI:1689143364
Name:COGGIN, WILLIAM CARL (PTA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CARL
Last Name:COGGIN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2647 GREENHORN RD
Mailing Address - Street 2:
Mailing Address - City:ROARING RIVER
Mailing Address - State:NC
Mailing Address - Zip Code:28669-8047
Mailing Address - Country:US
Mailing Address - Phone:336-566-9302
Mailing Address - Fax:
Practice Address - Street 1:1915 W PARK DR STE 102
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3777
Practice Address - Country:US
Practice Address - Phone:336-903-9293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-25
Last Update Date:2018-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA6587225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant