Provider Demographics
NPI:1710606421
Name:COELHO, STEPHANIE (DPT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:COELHO
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:PO BOX 411179
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-1179
Mailing Address - Country:US
Mailing Address - Phone:401-475-6599
Mailing Address - Fax:401-475-6425
Practice Address - Street 1:640 GEORGE WASHINGTOWN HIGHWAY
Practice Address - Street 2:BLDG 2
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865
Practice Address - Country:US
Practice Address - Phone:401-475-6599
Practice Address - Fax:401-475-6429
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT03564225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist