Provider Demographics
NPI:1699198416
Name:COUGHLIN, KATHLEEN C (DPT, PT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:C
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:C
Other - Last Name:HALLINAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1 CREDIT UNION WAY FL 3
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4633
Mailing Address - Country:US
Mailing Address - Phone:781-961-3370
Mailing Address - Fax:781-961-1291
Practice Address - Street 1:235 PLAIN ST STE 307
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3243
Practice Address - Country:US
Practice Address - Phone:781-961-3370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20888225100000X
RIPT03171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400130127OtherMEDICARE PTAN